Patho: Davis (Ch 16)

Question 3 of 15 Please select on the *figure where there is a delay in the signal in the electrical conduction pathway.

*At the AV node

Question 4 of 15 Which number on the following figure shows an electrocardiogram (ECG) associated with secondary atrioventricular (AV) heart block? 1 2 3 4

3

Increased PR interval duration is associated with which of the following? Couplet AV fibrillation AV block Bigeminy Ventricular fibrillation

AV block

Which conduction abnormality is associated with an increased risk for clot formation? PVC AV block AV fibrillation Couplet

AV fibrillation

Question 2 of 9 Given Helen's medical history, as well as her shortness of breath and feeling of dizziness, you believe she may be suffering from a myocardial infarction. The signs and symptoms of myocardial infarction may present differently in women. Which term applies to the signs and symptoms that may be present in a myocardial infarction that are not considered to be the typical presentation of chest pain? Levine's sign Angina equivalents Intermittent leg claudication Cushing's triad

Angina equivalents Angina equivalents are signs and symptoms associated with a myocardial infarction that differ from the typical angina pectoris presentation. Levine's sign is when a patient suffering from a myocardial infarction places his or her fist over the sternal area. Intermittent leg claudication and Cushing's triad are not associated with myocardial infarctions.

Question 9 of 15 On the following figure, please select where changes in the ECG revealing S-T segment elevation will appear.

At the ST segment

Question 13 of 15 On the figure, please select the waveform disrupted in atrial fibrillation.

Atrial depolarization of the P wave (pink area)

A patient's test results reveal a significant occlusion of a coronary artery, and bypass surgery is immediately scheduled. What is another term or acronym for bypass surgery? Stent PCTA Angioplasty CABG Echo

CABG

Question 15 of 15 Which procedure does the following image depict? TEE CABG DTR ECT

CABG

Which of the following treatments utilizes a catheter with a balloon that is inflated to restore blood flow? Stent CABG PCTA STEMI NSTEMI

CABG

Question 5 of 9 The physician requests that the cardiac biomarkers be tested over time. Which of the following is the expected pattern that may be present in Helen's samples? Both cardiac troponin I and creatine phosphokinase myocardial band peak within 30 minutes of myocardial infarction. Cardiac troponin I and creatine phosphokinase myocardial band will present with an inverse relationship. As one factor elevates, the other factor decreases. Cardiac troponin I elevates within the first 4 to 8 hours after onset of chest pain. Cardiac biomarkers return to baseline within hours of the onset of chest pain.

Cardiac troponin I elevates within the first 4 to 8 hours after onset of chest pain. Cardiac troponin I level rises within 4 to 8 hours of onset of chest pain. The cardiac biomarkers do not return to baseline levels for several days. The cardiac biomarkers do not have an inverse relationship; rather, with damage of myocardial cells, both cardiac biomarkers increase in the serum.

Question 8 of 15 Please place in the proper order how atherosclerosis may lead to a myocardial infarction. Coronary artery occlusion Decreased myocardial oxygen delivery Decreased myocardial blood flow Myocardial ischemia Myocardial infarction

Coronary artery occlusion Decreased myocardial blood flow Decreased myocardial oxygen delivery Myocardial ischemia Myocardial infarction

Question 12 of 15 Please place the following in order relating to how damage from a myocardial infarction may lead to an increase in stroke risk. Damage to the conduction circuit from myocardial infarction Reentry circuit Atrial fibrillation Blood stasis Increased clot formation

Damage to the conduction circuit from myocardial infarction Reentry circuit Atrial fibrillation Blood stasis Increased clot formation

Question 10 of 15 Which of the following should be on a chart that describes anginal equivalents, especially in women? Select all that apply. Dizziness Crushing chest pain Episodic dyspnea Pain in back Levine's sign

Dizziness Episodic dyspnea Pain in back

Question 8 of 8 John is eventually discharged from the hospital. However, John returns 10 days later complaining of chest pain and fever. He states the chest pain worsens when he takes a deep breath. On auscultation of John's chest, a pericardial friction rub is present. What has John developed? Beck's triad Dressler's syndrome Prinzmetal angina Syndrome X

Dressler's syndrome Dressler's syndrome may develop 2 to 3 weeks after a myocardial infarction. Dressler's syndrome is an autoimmune process in which antibodies and an inflammatory response occur as a result of cardiac proteins being released during a myocardial infarction. The immune complexes deposit in the pericardium, causing pericarditis. Pericarditis may present with a pericardial friction rub heard on auscultation.

Question 8 of 9 A follow-up angiography shows an occlusion in the left anterior descending artery. Percutaneous coronary intervention (PCI) was used to restore perfusion. Which of the following likely occurred for Helen during PCI? Drug-eluting stent placement Thallium stress test Heart valve replacement Aortic dissection

Drug-eluting stent placement A drug-eluting stent may be placed in the coronary artery to restore perfusion. Heart valve replacement is not considered during an MI. Thrombolytics rather than administration of clotting factors would be a treatment for myocardial infarction.

Question 4 of 9 The physician also orders a blood test for Helen. Which factor supports a diagnosis of myocardial infarction? Elevated LDL levels Elevated HDL levels Elevated Hct levels Elevated cardiac troponin I

Elevated cardiac troponin I Cardiac troponin I is a factor released from cardiac cells undergoing necrosis. This factor elevates in the blood after myocardial infarction and is considered to be the preferred biomarker for myocardial infarction. Creatine phosphokinase myocardial band is another cardiac marker; however, the absence of this factor in the blood would indicate an MI is likely not occurring. Low-density lipoprotein (LDL), high-density lipoprotein (HDL), and hematocrit (Hct) levels are not indicative of MI.

Question 7 of 8 John's pulmonary function is also being closely monitored. Over time, John seems to have difficulty maintaining adequate arterial oxygen levels. When you auscultate John's lungs you hear the presence of crackles. What complication do you suspect may be developing? Pneumonia Chronic obstructive pulmonary disease (COPD) Heart murmur Heart failure

Heart failure As John's left ventricle was damaged, it may not be able to adequately pump blood forward into circulation. The lack of forward ejection results in blood pooling in the left atrium and finally backing up into pulmonary circulation. As hydrostatic pressure in the pulmonary capillaries increases due to the fluid backup, fluid leaks from the capillaries, leading to pulmonary edema noted by the presence of crackles.

Question 3 of 9 Because of the concern of myocardial infarction (MI), the physician orders an electrocardiogram (ECG), which reveals Helen has ST segment elevation. Which of the following statements are true? Select all that apply. An ECG is the most definitive diagnostic test for an MI. Helen's results indicate the presence of STEMI. The ST segment elevation is a positive indicator for adequate perfusion of the heart. Helen's ECG indicates the next appropriate step is for Helen to be sent home with instructions to rest and drink plenty of fluids. The ECG results help explain why Helen was experiencing angina equivalents.

Helen's results indicate the presence of STEMI. The ECG results help explain why Helen was experiencing angina equivalents. An ECG is not the diagnostic test for MI, although it may provide important clinical information. The ST segment elevation indicates that Helen is likely experiencing a STEMI (ST segment elevation MI), causing complete occlusion of a coronary artery. The arterial occlusion would explain why Helen was experiencing angina equivalents.

Question 2 of 8 Coronary angiography reveals significant blockage in the coronary artery serving the anterior/inferior left ventricle. Which artery is occluded? Left anterior descending Circumflex Posterior interventricular Right marginal

Left anterior descending The left anterior descending (LAD) serves as the artery for the left ventricle (LV), particularly the anterior and inferior portions of the LV. The other arteries listed serve different portions of the heart, including the posterior aspect (posterior interventricular), right ventricle (right marginal), and left side of heart (circumflex).

Question 11 of 15 A patient has developed mitral valve insufficiency due to damage from a myocardial infarction. Which chamber of the heart is likely to experience an increased volume of blood due to this injury? Right atrium Right ventricle Left atrium Left ventricle

Left atrium

As a nurse working the emergency department, which of the following signs and symptoms are you concerned may indicate a patient is experiencing angina? Select all that apply. Levine's sign Muscle weakness Pain radiating to the jaw and neck Fever Pain alleviated with nitroglycerin

Levine's sign Pain radiating to the jaw and neck Pain alleviated with nitrates

Which of the following is a myocardial infarction in the left ventricle likely to cause? Pulmonary semi-lunar rupture Prinzmetal angina Mitral insufficiency Pulmonary valve insufficiency

Mitral insufficiency

Question 1 of 9 Helen is a 68-year-old woman who has been brought to the emergency department by her friend Karen. According to Karen, she and Helen had been working for several hours cleaning Helen's home. As they were finishing, Helen began to complain of heaviness in her chest, shortness of breath, and dizziness. These were not alleviated by Helen taking a nitroglycerin tablet and resting so Karen thought it best to bring Helen in for evaluation.As Helen experienced her symptoms, why may nitroglycerin tablets help? Nitroglycerin is known to alleviate dizziness. Nitroglycerin vasodilates arterioles helping with coronary blood flow. Nitroglycerine tablets are antianxiety medications. Nitroglycerin increases heart rate helping to maintain cardiac output.

Nitroglycerin vasodilates arterioles helping with coronary blood flow. Nitroglycerin vasodilates arterioles, helping to maintain blood flow to coronary tissue and alleviating chest pain.

Question 6 of 9 Helen's vital signs show a heart rate of 82 bpm, BP of 118/78 mm Hg, respiratory rate of 28 breaths per minute, and oxygen saturation of 93%. At the current time, what medication options may be selected for Helen? She continues to complain of heaviness in her chest. Select all that apply. Oxygen Aspirin IV nitrates Morphine Beta-adrenergic blockers

Oxygen Aspirin IV nitrates Morphine Beta-adrenergic blockers All of the listed options can be used to manage myocardial infarctions. Oxygen is given if saturation levels are less than 95%, aspirin reduces platelet aggregation, and nitrates and morphine may be used to alleviate pain. Beta blockers reduce the workload on the heart.

A single, widened QRS complex is referred to as a _______________. bigeminy PVC ventricular tachycardia couplet

PVC

Dysfunction of the following structures may result in a heart murmur? Pericardium Papillary muscles AV node Bundle branches

Papillary muscles

Question 3 of 8 When listening to John's heart you notice a heart murmur that was not noted on John's earlier health history. Which structures may have been damaged by John's myocardial infarction that elicited this new murmur? Superior vena cava Pulmonary artery Aorta Papillary muscles

Papillary muscles The papillary muscles are attached the atrioventricular (AV) valves and help keep the valves closed during ventricular systole. A myocardial infarction may damage the papillary muscles. If the papillary muscles can not function properly, the valve closure may be disrupted, enabling blood to flow through the valve during systole, resulting in turbulent flow and a heart murmur

Which of the following may be a complication following myocardial infarction? Select all that apply. Pericarditis Thromboembolism Increased ejection fraction Ventricular aneurysm Heart failure

Pericarditis Thromboembolism Ventricular aneurysm Heart failure

Following a myocardial infarction, the sac surrounding the heart may become inflamed. Which structure may develop inflammation? Pleural space Thymus Pleural membrane Pericardium

Pericardium

Question 2 of 15 Which phase of the following *image will most likely be disrupted by changes in extracellular calcium? Phase 1 Phase 2 Phase 3 Phase 4

Phase 2

Question 6 of 15 A nurse notices the following electrocardiogram (ECG) strip. Which of the following is the appropriate response? Return in a few moments to see whether the patient stabilizes. Recalibrate the ECG machine. Increased oxygen administration levels. Prepare for defibrillation.

Prepare for defibrillation.

Question 7 of 9 Which test is most helpful in revealing the extent of damage to Helen's heart? Echocardiogram Coronary artery bypass grafting (CABG) Venogram Radionuclide myocardial perfusion imaging

Radionuclide myocardial perfusion imaging Radionuclide myocardial perfusion imaging involves injecting a radionuclide dye into the bloodstream to highlight areas of the heart lacking perfusion. An echocardiogram cannot differentiate an acute MI from an old one, and a venogram examines the veins, not the coronary arteries.

Question 9 of 9 You are concerned that during Helen's treatment there may be further injury to myocardial cells by normalized oxygen levels. What is the term used for this type of injury? Reentry injury Repolarization injury Angina equivalents Reperfusion injury

Reperfusion injury Reperfusion injuries occur because damaged myocardial cells poorly tolerate normalized levels of oxygen.

Of the following characteristics, which is associated with a STEMI? Partial occlusion of coronary artery ST segment elevation Partial thickness damage of heart muscle Relatively benign condition Treatment limited to nitroglycerin tablets

ST segment elevation

Question 1 of 8 John, age 58, has presented in the emergency department complaining of severe chest pain. He states that two nitroglycerin tablets did not alleviate his pain. An electrocardiogram (ECG) is immediately ordered, along with serum laboratory values for cardiac markers.John's ECG revealed a 4-mm ST segment elevation in V2-V6. Which of the following best describes John's condition? NSTEMI STEMI Partial occlusion of coronary artery Stable angina

STEMI The ST segment elevation indicates John is experiencing an ST elevation myocardial infarction (STEMI) event, not a non-ST elevation myocardial infarction (NSTEMI), in which no ST segment elevation would be apparent. A STEMI indicates complete, not partial, occlusion of a coronary vessel. The fact that John's pain was not relieved with nitroglycerin shows it is not stable angina.

Question 5 of 8 Because of the damage to the left ventricle, the physician is concerned about poor ejection and stasis of blood in the ventricular chamber leading to further complications. Which of the following may be a primary concern? Atrial fibrillation Thromboembolism First degree AV block Collateral circulation development

Thromboembolism When stasis of the blood occurs, the risk of clot development increases. In John's case, a poorly performing left ventricle may increase the risk of a thromboembolism forming. This clot can then travel from the heart to other tissues, such as the lungs.

Which of the following statements about angina are true? Select all that apply. Angina pectoris is cardiac chest pain that occurs when there is lack of blood flow to the myocardium. Increased oxygen levels and lactic acid formation may play a role in angina. Unstable angina is chest pain the patient is experiencing for the first time. Stable angina is considered a medical emergency. Unstable angina may indicate new damage to the heart.

Unstable angina may indicate new damage to the heart. Angina pectoris is cardiac chest pain that occurs when there is lack of blood flow to the myocardium. Unstable angina is chest pain the patient is experiencing for the first time.

Question 7 of 15 A patient is to receive a quadruple coronary artery bypass graft. What is the result of the procedure? Create a bypass around the four chambers of the heart. Reconnect vessels to connect the heart chambers differently. Use harvested vessels to circumvent four arterial blockages. Place four stents in the heart arteries.

Use harvested vessels to circumvent four arterial blockages.

Question 1 of 15 A patient has consistent chest pain with exertion due to partial occlusion of a coronary artery. The patient is given a prescription for nitroglycerin tablets. Which of the following processes is the purpose of the prescription? Pain blockage Vasoconstriction Clot buster Vasodilation

Vasodilation

Question 6 of 8 The physician orders an echocardiogram to get a better sense of John's heart function. There is a bulging left ventricular wall. Which of the following terms describe this development? Cardiac tamponade Papillary muscle rupture Ventricular aneurysm Pericarditis

Ventricular aneurysm A ventricular aneurysm is a bulge in the ventricular wall that develops as a result of damage to the tissue. A primary concern of a ventricular aneurysm is that the bulge may rupture leading to a medical emergency. Surgical repair of a ruptured ventricular aneurysm is critical.

Question 5 of 15 A nursing instructor is asking a nursing student to interpret the following electrocardiogram (ECG). Which shows correct understanding by the student? Waveform showing a primary atrioventricular (AV) block An example of bigeminy Form of ventricular tachycardia Ventricular beat independent of normal conduction signal

Ventricular beat independent of normal conduction signal

As a nurse examining ECGs, the appearance of which of the following would be most worrisome to you? Ventricular fibrillation Single PVC Atrial fibrillation AV block

Ventricular fibrillation

Question 14 of 15 A nurse sees the following electrocardiogram (ECG). What is the correct interpretation for the nurse to make? Atrial fibrillation Problem with the telemetry device Ventricular fibrillation Premature ventricular contractions

Ventricular fibrillation

Question 4 of 8 The physician is closely monitoring John's ECG because she is worried about a rhythm disturbance that may develop as a result of reentry circuits. Given John's current presentation, which of the following is the most concerning? First degree AV block Ventricular tachycardia Atrial fibrillation A single premature ventricular contraction (PVC)

Ventricular tachycardia Because of the location of John's myocardial infarction, you are most concerned about a conduction disturbance in the ventricles. Ventricular tachycardia is the most worrisome of the conduction disorders listed as it can result in inadequate pumping of blood from the left ventricle. Atrial disorders or a single PVC do not normally result in significant decline in ventricular function at rest.

Rapid, irregular P waves are known as ____________. AV block atrial fibrillation ventricular fibrillation ventricular tachycardia

atrial fibrillation

A patient is diagnosed with a STEMI in the emergency room. This means the patient is experiencing/requires. an aneurysm. complete occlusion of a coronary artery. a minor injury to the heart. a normal appearing ECG. careful observation but no treatment at this time.

complete occlusion of a coronary artery.

Myocardial infarction _________________________. Select all that apply. is synonymous with myocardial ischemia. indicates death of heart tissue. results from increased oxygenation of heart tissue. may produce abnormalities on an ECG. usually resolves on its own, without any treatment.

indicates death of heart tissue may produce abnormalities on an ECG.

Stable angina _____________________. is another name for a heart attack. requires immediate surgical correction. is consistent, chronic chest pain. occurs without signs or symptoms. is chest pain experienced for the first time.

is consistent, chronic chest pain.

Factors that influence the amount of damage an MI causes include _____________. Select all that apply. location gender duration collateral circulation age

location duration collateral circulation

Angina may be relieved by ______________, which vasodilate(s) coronary arteries. glucose tablets oxygen sedatives nitroglycerin tablets morphine

nitroglycerin tablets

A block at the AV node is likely to appear as a(n) ___________________ on an ECG. widened QRS complex PVC prolonged PR interval inverted P wave

prolonged PR interval