Chapter 13
24. (p. 257) _____ remains an underdiagnosed and untreated contributor to CHD morbidity and mortality.
A. High cholesterol B. Hostility C. Genetics #D. Depression
17. (p. 255) Higher levels of hostility have been found among:
A. women. B. whites. C. people high in socioeconomic status (SES). #D. men.
3. (p. 251) Raj, who complains of chest pain, is admitted to a hospital. The diagnosis reveals that his blood vessels have narrowed and the flow of oxygen and nourishment to his heart has been interrupted. He is, in this case, suffering from _____.
#A. Alzheimer's disease B. coronary heart disease C. cardiovascular disease D. Parkinson's disease
13. (p. 255) Which of the following personality qualities reflects a positive caring orientation to others?
#A. Communion B. Agency C. Unmitigated agency D. Unmitigated communion
26. (p. 258) _____ is a common treatment for cardiac patients that treats blockage of major arteries in the heart.
#A. Coronary artery bypass graft B. Transmyocardial laser revascularization C. Heart transplant D. Angioplasty
21. (p. 257) Which of the following is true of depression?
#A. It is an independent risk factor for CHD. B. It is a psychological by-product of other risk factors for CHD. C. It is based on genetic factors. D. It is unrelated to metabolic syndrome.
30. (p. 260) _____ are the most common drugs prescribed for patients following an acute coronary event or a stroke.
#A. Statins B. Diuretics C. Beta-blockers D. Vitamins
36. (p. 261) Sudden death from heart attack is most likely to occur:
#A. at home. B. at work. C. on vacation. D. while the patient is asleep.
18. (p. 256) The relation between hostile style and enhanced cardiovascular reactivity to stress is most reliable for _____.
#A. men B. women C. children D. adults
33. (p. 261) Cardiac invalidism occurs when:
#A. patients and their spouses underestimate a patient's physical abilities. B. spouses underestimate the extent of a patient's disabilities. C. patients malinger in order to reap secondary gains associated with the sick role. D. patients feel that they are unable to control the stressors in their daily lives.
16. (p. 255) Cynical hostility is characterized by:
#A. suspiciousness. B. optimism. C. infrequent angry episodes. D. trust in others.
39. (p. 262) Diastolic pressure is related to:
#A. the resistance of the blood vessels to blood flow. B. the amount of force developed during contraction of the heart. C. the volume of blood leaving the heart. D. the elasticity of the arteries.
54. (p. 370) Poor adherence to diabetic regimens by people with Type II diabetes most often is due to:
#A. transient situational factors. B. demographic factors. C. personality factors. D. cognitive-behavioral factors.
2. (p. 251) Coronary heart disease is:
A. unrelated to the changes in diet. #B. a disease of modernization. C. prevalent among children. D. unrelated to social status.
7. (p. 251) According to a study by Lawlor et al. (2005), risk factors for heart disease begin to cluster by age _____ for those low in SES.
A. 32 B. 43 #C. 14 D. 25
4. (p. 251) Which of the following is a risk factor for coronary heart disease?
A. Abnormal weight loss B. Low serum cholesterol C. Curvature of the spine #D. Diabetes
53. (p. 268) _____ involves a delicate balance between insulin production and insulin responsiveness.
A. Cardiac invalidism. B. Fructose metabolism C. Hypothyroidism #D. Glucose metabolism
10. (p. 253) Which of the following job factors relates to increased risk of CHD?
A. Discrepancy between occupation and diet B. Discrepancy between occupation and family life C. High social support at work #D. High work demands and low control
9. (p. 253) Which of the following is true of the impact of social factors on CHD?
A. Industrialized countries have a very low incidence of CHD. B. People who are less mobile have a higher frequency of CHD. C. Social stability is linked to higher rates of CHD. #D. Migrants have a higher incidence of CHD.
14. (p. 255) Which of the following best describes unmitigated communion?
A. It is a focus on the self. B. It is a focus on social unity. #C. It is an extreme focus on others. D. It is an extreme focus on oneself.
8. (p. 252) According to a study by Troxel et al. (2003), _____ are disproportionately exposed to chronic stress and are at an elevated risk for CHD.
A. Native Americans #B. African Americans C. Asian Americans D. Pacific Islanders
55. (p. 271) Which of the following best predicts compliance with a diabetic treatment regimen?
A. Restricting the number of persons in the diabetics' social support network B. Training the diabetics' to discriminate when their blood glucose level needed to be modified #C. Improving the diabetics' ability to independently regulate their own behavior D. Following strict stress management and relaxation training programs
25. (p. 258) _____ refers to chronically searching the environment for potential threat.
A. Rumination B. Due diligence #C. Vigilant coping D. Type-A behavior
37. (p. 261) _____ is a useful indicator of the functional capacity of recovering myocardial infarction patients.
A. Thallium scanning B. Echocardiogram C. Psychometric test #D. Treadmill test
49. (p. 266) Which of the following is true of stroke?
A. The likelihood of a stroke decreases with age. B. Stroke occurs more often in women than in men. C. Stroke does not occur among those who have diabetes. #D. Stroke risk factors overlap with those for heart disease.
11. (p. 254) Which of the following is true of heart diseases in women?
A. They are less likely to die from a first heart attack than men. #B. They experience an increased risk of cardiovascular disease after menopause. C. They develop CHD on the average about 15 years earlier than do men. D. They are protected at young ages against CHD due to their lower levels of HDL cholesterol.
38. (p. 262) _____ is largely a symptomless disease.
A. Type II diabetes B. Stroke #C. Hypertension D. CHD
12. (p. 255) The personality quality "agency" is associated with _____.
A. a focus on others #B. a focus on oneself C. relationships D. self-sacrifice
48. (p. 266) The risk factors for stroke:
A. are independent of those for heart disease. B. decrease with age. C. are not subject to modification by lifestyle changes. #D. include cigarette smoking.
46. (p. 264) Drug treatments for hypertension:
A. are less effective than dietary modification and exercise. B. significantly reduce the incidence of coronary artery disease, morbidity, or mortality. C. show some success in reducing blood pressure without negative side effects. #D. may increase the CHD risk caused by enhanced sympathetic nervous system activity.
22. (p. 257) Depression in people who are hostile and in African Americans is likely to be closely linked to:
A. atypical antidepressant. B. monoamine oxidase inhibitor. #C. C-reactive protein. D. tricyclic antidepressant.
23. (p. 257) Depression is typically treated with Prozac which is a(n):
A. atypical antidepressant. B. monoamine oxidase inhibitor. #C. serotonin reuptake inhibitor. D. tricyclic antidepressant.
34. (p. 261) In a study of cardiac invalidism (Taylor et. al, 1985), wives' perceptions of their husbands' cardiac and physical efficiency were highest when they had:
A. been provided information about their husband's medical and psychological condition. B. observed their husband's performance on a treadmill task. #C. personally experienced the treadmill task themselves. D. been informed that a treadmill task is going to be conducted.
40. (p. 262) Men and women in the United States face a similar chance of developing hypertension:
A. between ages 45 and 54. #B. between ages 55 and 64. C. before age 25. D. after age 65.
35. (p. 261) CPR is:
A. cardiopulmonary relief. B. cardiac prevention resources. C. cardiopretension resuscitation. #D. cardiopulmonary resuscitation.
50. (p. 267) Patients with right-brain damage due to stroke typically suffer:
A. communication disorders such as aphasia. B. impaired performance on cognitive tasks that require the use of short-term memory. #C. difficulty in processing visual feedback. D. extreme anxiety and depression.
1. (p. 251) The number one killer in the United States, accounting for one out of every six deaths, is:
A. diabetes. #B. coronary heart disease. C. hypertension. D. cancer.
5. (p. 251) The combination of obesity centered around the waist, high levels of triglycerides, low levels of HDL cholesterol, and difficulty metabolizing blood sugar are symptomatic of:
A. diabetes. #B. metabolic syndrome. C. angina pectoris. D. hypertension.
19. (p. 256) Hostile people exhibit a _____ response to sympathetic activity in response to stress.
A. friendly B. strong pessimistic C. favorable #D. weak antagonistic
20. (p. 256) Individuals who are high in hostility:
A. have chronically lower blood pressure. B. show lower heart rate reactivity to laboratory stressors. #C. show exaggerated cardiovascular reactivity. D. show strong antagonistic responses to sympathetic activities.
27. (p. 258) Patients with myocardial infraction are treated in a(n) _____ unit where their cardiac functioning is continually monitored.
A. hospice care #B. coronary care C. home care D. acute care
51. (p. 267) Alexithymia:
A. involves difficulty in understanding others and expressing oneself. #B. involves difficulty in identifying and describing emotion. C. involves difficulty in recognizing individual faces. D. involves problems with short-term memory.
52. (p. 268) Type II diabetes:
A. is likely to develop only after age 60. B. is the number-one killer in the United States. C. is a rare phenomenon among children. #D. is a non-insulin-dependent diabetes.
43. (p. 263) The role of stress in the development and exacerbation of hypertension:
A. is the same for people at risk for hypertension and those who are not at risk. B. does not change as hypertension progresses. #C. may be different for people at risk for hypertension. D. has not been studied enough to determine its role in hypertension.
44. (p. 263) The prevalence of hypertension among lower-income African Americans is most likely due to:
A. lower waist-to-hip ratio. B. higher high-density lipoprotein cholesterol level. C. lower fasting insulin levels. #D. greater body mass.
47. (p. 264) Cognitive-behavioral techniques:
A. may substitute for drug treatments, in case of severe hypertension. B. are expensive and highly difficult to implement. #C. can be used without supervision and have no side effects. D. have been moderately successful in the treatment of hypertension.
41. (p. 262) A systolic pressure consistently between 140 and 159 is associated with:
A. moderate hypertension. B. severe hypertension. #C. mild hypertension. D. D.critical hypertension.
32. (p. 261) According to studies of recovery from coronary heart disease, social support is:
A. most effective when it is provided by the spouse rather than a confidante. B. increasingly ineffective over time as the patients recover from their illness. #C. a problem for some patients if not given in a careful way. D. most effectively used by people high in cynical hostility.
42. (p. 263) According to a study of hypertension risk factors by Ewart (1991), a family environment that fosters _____ contributes to hypertension.
A. negative affectivity #B. chronic anger C. excessive competitiveness D. cynical distrust
31. (p. 261) Cardiac rehabilitation programs involve:
A. no exercise. B. rehospitalization. C. minimum alcohol consumption. #D. smoking cessation.
6. (p. 251) Gerard is obese around the waist. He has high blood pressure and low levels of good cholesterol. These are symptomatic of:
A. stroke. B. hypertension. C. multiple sclerosis. #D. metabolic syndrome.
15. (p. 255) People who are both hostile and _____have an increased risk for metabolic syndrome and CHD.
A. suspicious #B. angry C. defensive D. ambitious
45. (p. 264) "John Henryism" is a personality predisposition:
A. that helps African American men cope with racism. B. that proves active coping is likely to be unsuccessful. #C. that enables to actively cope with psychosocial stressors. D. that is found only in white men.
28. (p. 259) Successful cardiac rehabilitation depends critically on:
A. the cost involved in the treatment. B. a medical practitioner's involvement. #C. a patient's active participation and commitment. D. the level of cynical hostility shown by medical staff.
29. (p. 259) Beta-blockers are used in cardiac rehabilitation:
A. to activate the parasympathetic nervous system. #B. to resist the effects of sympathetic nervous system stimulation. C. to control the pain of angina pectoris. D. to restrict the negative side effects of the administered drugs.
69. (p. 263) What ethnic differences have been found in the incidence of hypertension? What racial and psychosocial factors may be implicated in these ethnic differences?
Answers will vary Feedback: Hypertension is a common medical problem in African American communities. Its high prevalence is tied to stress and low SES. Hostility and anger may also contribute to this ethnic difference. Low-income blacks are especially vulnerable. They are likely to live in stressful neighborhoods. Exposure to discrimination and racism can contribute to high blood pressure among blacks, possibly by interfering with the normal decline in blood pressure at night. African Americans have an elevated risk of obesity, which is tied to hypertension. Cardiovascular reactivity among African Americans, especially older African Americans, may be part of a more general syndrome that implicates multiple risk factors for CVD, including greater heart rate reactivity, higher fasting insulin levels, lower high-density lipoprotein cholesterol levels, a higher waist-to-hip ratio, and greater body mass overall. Students' answers will vary
67. (p. 260) Explain the relationship of lifestyle factors to coronary heart disease and cardiac rehabilitation.
Answers will vary Feedback: Most patients involved in cardiac rehabilitation are given dietary instructions and put on an exercise program involving walking, jogging, bicycling, or other exercises at least three times a week for 30-45 minutes. Exercise improves prognosis and may be especially important for people low in SES with or at risk for coronary heart disease. Younger patients, women, and people with little social support, high social conflict, and negative coping styles are most at risk for high stress, and therefore require stress management.
66. (p. 251-253) Maria often complains of negative emotions, stress, and emotional pressures at work. Her colleague, Tandra, says that constant stress can trigger acute coronary events and advises her to meet a doctor. Support Tandra's statements by citing the research on emotion and CHD.
Answers will vary Feedback: Stress is an important culprit in the development of CHD and may interact with genetically-based weaknesses to increase its likelihood. Extensive research links chronic and acute stress to CHD and to adverse clinical events (Phillips, Carroll, Ring, Sweeting, & West, 2005; Vitaliano et al., 2002). Acute stress involving emotional pressure, anger, extreme excitement (Strike & Steptoe, 2005), negative emotions, and sudden bursts of activity can precipitate sudden clinical events, such as a heart attack, angina, or death (Lane et al., 2006; Nicholson, Fuhrer, & Marmot, 2005). The stress reactivity associated with these events can lead to plaque rupture and risk of a clot. This process may explain why stress can trigger acute coronary events such as heart attacks (Strike, Magid, Brydon, Edwards, McEwan, & Steptoe, 2004). Stress has been linked directly to increased inflammatory activity as well (McDade, Hawkley, & Cacioppo, 2006). Stress in the workplace can lead to the development of coronary heart disease. Job-related risk factors are: job strain, especially the combination of high work demands and low control; a discrepancy between educational level and occupation; low job security; little social support at work; and high work pressure.
68. (p. 260) Explain the role of stress management in recovery from myocardial infarction.
Answers will vary Feedback: Stress management is an important ingredient in cardiac rehabilitation because stress can trigger fatal cardiac events. The patient is taught how to recognize stressful events, how to avoid stress when possible, and what to do about stress if it is unavoidable. Training in specific techniques, such as relaxation and mindfulness, improves the ability to manage. Some stress management interventions target hostility. Declines in hostility in midlife are associated with lower risk.
70. (p. 270) Explain why adherence to diabetic treatment programs is so difficult for most people to achieve.
Answers will vary Feedback: The key to the successful control of diabetes is active self-management. However, adherence to lifestyle change is problematic. Many Type II diabetics fail to recognize that they have a chronic health condition that requires sustained commitment to medications and behavior change, and so ensuring that these patients have the correct beliefs about their illness is critical to adherence. Generally, social support improves adherence, but this is not as true for diabetes. Social contact can lead to temptations to eat that compromise diabetic functioning.
57. (p. 251) Identifying patients with metabolic syndrome rarely helps predict heart attacks.
FALSE
58. (p. 253) Across the life span, women seem to be protected against coronary heart disease relative to men.
FALSE
59. (p. 255) People who are high in cynical hostility generally have a high level of social support.
FALSE
64. (p. 262) Mild hypertension is defined by a diastolic pressure consistently between 105 and 119.
FALSE
56. (p. 251) Diabetes is a risk factor for coronary heart disease.
TRUE
60. (p. 256) Research suggests that expressing anger is more reliably associated with cardiovascular reactivity than the state of anger.
TRUE
61. (p. 258) Vigilant coping is a risk factor for heart disease.
TRUE
62. (p. 259) Successful cardiac rehabilitation depends critically on the patient's active participation and commitment.
TRUE
63. (p. 259) Aspirin has been found to significantly reduce the risk for fatal heart attack.
TRUE
65. (p. 265) The mortality rate is around 30 percent during the first month after a stroke.
TRUE