Patho Exam 3 Practice Questions

The physician states that a client has adequate collateral circulation. The nurse interprets this as:

Long-term compensatory regulation of blood flow

The mucociliary blanket

- protects the respiratory system by entrapping foreign particles in mucus; then cilia move the mucus with trapped particles upward toward the oropharynx to be coughed out or swallowed. - The blanket supplies water from the mucous membrane to add moisture to inhaled air. - Heat is transferred into the air from blood flowing in the walls of the airway - Serous glands in the epithelial layer secrete the antibacterial enzymes.

Dyspnea can best be described by which of the following?

A subjective sensation felt when experiencing difficulty breathing

Select the response that best describes the pressure-sensitive receptors that respond to changes in the stretch of the vessel wall.

Baroreceptors

A client is diagnosed with pulmonary embolism. Which symptom would most likely be present?

Chest pain and dyspnea

Which class of cardiac antiarrhythmic drugs extends the action potential and refractoriness of the heart's contraction?

Class III

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

Immune-mediated inflammation

A client recently had surgery for a hip fracture. Which nursing intervention would be most effective for preventing pulmonary emboli in this client?

Prevention of the development of a deep vein thrombosis

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 possible diagnosis?

Small cell lung cancer due to smoking history

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

Sympathetic nervous system

The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of deep vein thrombosis (DVT). Which nursing intervention should the nurse implement?

apply sequential pneumatic compression devices to lower extremities

Right-sided rather that left-sided heart failure causes blood to

back up in the venous circulation, resulting in edema.

In left-sided failure, the left ventricle pumps inefficiently

blood backs up in the pulmonary circulation, and less, rather than more, blood enters the carotid arteries.

Increased blood volume and systemic vasoconstriction will increase

blood pressure

central chemoreceptors are the most important in sensing

changes in carbon dioxide levels

Which client is exhibiting signs of advanced chronic obstructive pulmonary disease (COPD)?

client sitting in bed resting elbows on the overbed table, expiratory wheezes noted

Which client will the nurse prioritize to assess first?

client with sinus arrest

Which disease is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?

constrictive pericarditis

the tunica media of a vessel is largely a smooth muscle layer that

constricts to regulate and control the diameter of the vessel

Serotonin causes vasoconstriction and plays a major role in

control of bleeding

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 murmur of mitral valve stenosis is heard during

diastole when blood is flowing through the constricted valve; it is characteristically a low-pitched, rumbling murmur best heard at the apex of the heart.

While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by

recording weight every day at the same time with same type of clothing.

Diastole occurs when the ventricles are

relaxed and blood fills the heart

Baroreceptors are pressure-sensitive receptors located in the

walls of blood vessels and the heart

ACE inhibitors inhibit bradykinin degradation in the lungs

which can cause a common side effect of a dry, nonproductive cough

What can trigger myocardial ischemia even when there is adequate coronary oxygen supply?

- anemia - carbon monoxide poisoning - hypoxia

The heart valves control the direction of blood flow from the

- atria to the ventricles (the AV valves) - the right side of the heart to the lungs (pulmonic valves) - the left side of the heart to the systemic circulation (aortic valve)

cardiac tanponade

- can be life-threatening - S: tachycardia, elevated central venous pressure, jugular vein distention, and fall in systolic blood pressure with narrowed pulse pressure

A nurse is planning a community education program on lifestyle modification to manage hypertension. Which topic should be included in the teaching plan?

- consume a diet rich in fruits, vegetables, and low-fat dairy products - reduce dietary sodium intake - stop smoking - limit alcohol consumption

Which sequence is the correct pathway for blood flow through the heart?

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

Completion of a client's pulmonary function study has yielded the following data: tidal volume, 500 mL; inspiratory reserve, 3100 mL; expiratory reserve, 1200 mL; residual volume, 1200 mL; functional residual capacity, 2400 mL. What is this client's inspiratory capacity?

3600 mL - Inspiratory capacity is the sum of inspiratory reserve volume (IRV) and tidal volume: 3100 + 500 = 3,600.

A client is admitted to the cardiac unit with a diagnosis of pericarditis. The nurse is teaching the client 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

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

Activated cells that release free radicals oxidize LDL, which is harmful to the lining of your blood vessels. - Oxidized LDL is toxic to the endothelium, causing endothelial loss and exposure of the subendothelial tissue to the blood components. This leads to platelet adhesion and aggregation and fibrin deposition.

A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are prescribed by the health care provider. Which intervention should the nurse complete first?

Administer epinephrine (adrenaline).

A client sustained a puncture injury to the chest resulting in development of a tension pneumothorax. What is the pathogenesis behind a tension pneumothorax?

Air is permitted to enter but not leave the pleural space, causing lung collapse.

Acute-onset bronchial asthma causes wheezing and breathlessness as a result of which of the following?

Airway inflammation

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

Alzheimer disease - IS: primary lung diseases, such as pneumonia, asthma, and emphysema; heart disease that is characterized by pulmonary congestion; and neuromuscular disorders, such as myasthenia gravis and muscular dystrophy that affect the respiratory muscles.

A client has been diagnosed with atrial flutter. Which assessment finding correlates with this diagnosis?

An atrial heart rate above 240 beats/min

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

Anaphylactic

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 nurse is caring for a client who suffered a massive myocardial infarction and is scheduled for an immediate permanent pacemaker insertion due to severe ischemia and damage to both SA and AV nodes. The nurse would expect which of the following?

Bradycardia with rate of 20-40

sequence of blood return to the heart

Capillaries, venules, veins, right atrium

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 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

What intervention is appropriate for a client with sarcoidosis?

Corticosteroids

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

Hypertension

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 older adult client is prescribed a vasodilator for hypertension. Which adverse effect is of greatest concern for an older adult taking this class of drug?

Hypotension

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

Immediate defibrillation

The nurse knows that which statement regarding heart failure is most accurate?

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

A nursing instructor is explaining arterial circulation to a group of nursing students. What is the most appropriate information for the nurse to provide concerning arterial pressure gradient in the arterial side of systemic circulation?

It contains one-sixth of the total blood volume.

Which of the following is true regarding pulmonary circulation?

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

A 66-year-old man presents in the emergency room accompanied by his wife, who claims that he has been acting confused. The man reports a sudden onset of severe weakness and malaise and has a dry cough and diarrhea. His temperature is 39.3°C, and his blood work indicates his sodium level is at 126 mEq/L (126 mmol/L). The normal level is 135-145 mEq/L (135 to 145 mmol/L). What will be the assessing physician's most likely suspicion?

Legionnaire disease

Confusion, dry cough, diarrhea, and hyponatremia are associated with

Legionnaire disease

Which of the following are characteristic signs of acute arterial embolism?

Pallor, pulselessness, and pain

A nurse is observing the cardiac monitor of a client that suddenly displays a regular rhythm with absent P waves and a heart rate of 200 beats/min. The nurse interprets these findings as resulting from:

Paroxysmal supraventricular tachycardia

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

Perfusion without ventilation

The nurse is evaluating a client with cardiac problems and notes that the client's peripheral pulse is different than the apical pulse. To which physiologic response would the nurse attribute the difference in rates?

Premature beats not following normal conduction pathways

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

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:

Pulmonary embolism

The nurse needs to assess the oxygen status of a client who is suddenly experiencing shortness of breath. The most appropriate noninvasive measurement technique would be:

Pulse oximetry

The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?

QRS complex

ventricular depolarization by the

QRS complex

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 drug will the nurse anticipate administering first?

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

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

A 28-year-old marathon runner comes to the clinic to obtain a physical exam for a new job. The nurse assesses a regular pulse rate of 52 beats per minute (bpm). Which common dysrhythmia is the nurse aware this client most likely has related to maintaining a large stroke volume?

Sinus bradycardia

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 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

A 6-month-old infant has been hospitalized with acute bronchiolitis. Which treatment should be prioritized in the infant's care?

Supplementary oxygen therapy

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.

A client with a history of angina presents with uncharacteristic chest pain. The subsequent electrocardiogram (ECG) reveals T-wave elevation. This finding suggests an abnormality with which aspects of the cardiac cycle?

Ventricular repolarization

peripheral chemoreceptors function in sensing

arterial blood oxygen levels

A child is experiencing an acute exacerbation of asthma. Which quick-acting treatment is most appropriate for this client?

beta-adrenergic agonists

An older adult client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by:

blocking the conversion of angiotensin I to angiotensin II.

Reduced heart rate will lower

blood pressure

The cardiovascular center transmits impulses to the

blood vessels

here are two groups of chemoreceptors

central and peripheral.

The isoelectric or zero line between the P wave and the Q wave represents

depolarization of the atrioventricular node, bundle branches, and Purkinje system

after relative refractory period is the supernormal excitatory period

during which even a weak stimulus could evoke a response potential, sparking a cardiac dysrhythmia

Elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels are associated with

dyslipidemia

The relative refractory period occurs at the

end of phase 3

The lymphatic system

filters fluid at the lymph nodes and removes foreign particles such as bacteria

pericardium (pericardial sac)

forms a fibrous covering around the heart, holding it in a fixed position in the thorax and providing physical protection and a barrier to infection. The pericardium is a tri-layer sac consisting of a tough, outer fibrous layer and a thin, inner serous layer.

A client asks the nurse if cold medicine containing a decongestant is safe to take. The nurse recommends the client avoid decongestants if the client has which condition?

hyperthyroidism

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 blood pressure 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.

Axially, crosswise, and turbulent blood flow would result in

increased friction

Acute pericarditis is due to

inflammation of the pericardium

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.

Collateral circulation is a mechanism for the

long-term regulation of local blood flow

Three days following surgical repair of a hip fracture a client becomes anxious and reports sudden shortness of breath and chest pain that worsens with a deep breath. Which disorder is the client likely experiencing?

pulmonary embolism

Which are the semilunar valves?

pulmonic and aortic

The action potential is an alternating electrical charge that enables electrical conduction in heart muscles, controlled by

the passage of electrolyte ions through ion channels (in particular sodium, potassium and calcium) that stimulate contraction and relaxation of the heart

Prostaglandins (synthesized from constituents of the cell membrane like long-chain fatty acid, arachidonic acid) produce either

vasoconstriction or vasodilation

Premature ventricular contractions results in the

ventricles contracting early.

The T wave on an ECG corresponds to

ventricular repolarization

Which individual should have priority for receiving a seasonal influenza vaccination?

An older adult resident of a long-term care facility

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

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

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

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

Epiglottitis

What does the equation C = ΔV/ΔP stand for?

Lung compliance

Atrial depolarization is represented by the

P wave

the arterial system

distributes oxygenated blood to the tissues

The aortic pressure reflects changes in the ejection of blood from the

left ventricle

When lymph flow is obstructed, a condition called

lymphedema occurs

The left atrium receives oxygenated blood from

the lungs

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 nurse is caring for a client with an average heart rate of 56 beats/min. The client has no adverse symptoms associated with this heart rate and is receiving no treatment. Which activity modification should the nurse suggest to avoid further slowing of the heart rate?

"Avoid bearing down while having a bowel movement."

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

An older adult client who was recently diagnosed with emphysema asks the nurse what caused the disease. Which statement 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?"

A nurse is observing a client's cardiac status by telemetry monitoring. On the monitor, the P wave changes shape and an impulse frequently occurs before the next expected sinoatrial (SA) node impulse. The nurse interprets this rhythm by stating:

"The client is experiencing premature atrial contractions (PACs)."

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."

Class III drugs

(e.g., amiodarone, bretylium, ibutilide, dofetilide, and sotalol) act by inhibiting the potassium current and repolarization, thereby extending the action potential and refractoriness.

Class II drugs

(e.g., propranolol, metoprolol, atenolol, timolol, sotalol) are beta-blockers that act by blunting the effect of sympathetic nervous system stimulation on the heart, thereby inhibiting calcium channel opening. - these drugs decrease automatically by depressing phase 4 of the action potential

Class IV drugs

(e.g., verapamil, diltiazem, and mibefradil) act by blocking the slow calcium channels, thereby depressing phase 4 and lengthening phases 1 and 2 of the action potential.

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

- Carbon dioxide - Oxygen - pH

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

- HIV infection - scleroderma - family history

What 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 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 manifestations are characteristic of Legionnaire pneumonia? Select all that apply.

- Temperature of 103.5°F (39.7°C), pulse 80 - "Talking but not making a lot of sense" (confusion) - Chest x-ray that reveals areas of consolidation suggestive of pneumonia

In the heart, anastomotic channels exist between some of the smaller arteries.

- These channels permit perfusion of an area by more than one artery - When one artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel.

Oxygen has been prescribed for a client with chronic obstructive pulmonary disease (COPD). Which amount of oxygen is considered most appropriate for the COPD client?

1 to 2 L/min

Stage 1 hypertension has a systolic pressure between

130 and 139 mm Hg

The nurse suspects a client has stage 2 systolic hypertension. What systolic pressure would confirm the nurse's suspicion?

140 mm Hg or higher

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

140/90

In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which level indicates inadequate renal perfusion?

20 mL/hour

proteinuria (300 or greater in 24 hours) developing after

20 weeks of gestation

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

25-30%

The action potential has

5 phases

Four clients 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 client most likely experienced myocardial infarction?

80-year-old woman whose pain 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 client most likely faces the highest risk of developing secondary pulmonary hypertension?

A client with COPD and a 35 pack-year smoking history.

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

A pulsating mass in the abdomen

A client taking an antihypertensive drug for several months comes to the physician's office with a dry, persistent cough. The nurse knows that this cough is an adverse effect of which class of antihypertensive drugs?

Angiotensin-converting enzyme (ACE) inhibitors

A child's history of a recurrent sore throat followed by severe knee and ankle pain has resulted in a diagnostic workup and a diagnosis of rheumatic fever. What are the treatment priorities for this child?

Antibiotics and anti-inflammatory drugs

Which cardiac drug classification decreases sympathetic outflow to the heart and is the is the cornerstone of therapy for catecholaminergic polymorphic ventricular tachycardia (CPVT)?

Beta-adrenergic blockers

Which antiarrhythmic medication works by blunting the effect of sympathetic nervous system stimulation on the heart?

Beta-blockers, such as metoprolol

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

Coronary artery bypass grafting (CABG) is a treatment modality for which disorder of cardiac function?

Atherosclerosis and unstable angina

Paroxysmal supraventricular tachycardia arises from which form of reentry?

Atrioventricular (AV) nodal

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

Blood culture

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

Carbon monoxide poisoning

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

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

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 physiologic measurement?

Diffusion capacity

In first-degree block the AV conduction is delayed, but all impulses do get conducted.

With second-degree block some impulses may get through while others do not.

A client presents to the emergency department with a sudden onset of acute pain in his left lower leg. The practitioner is unable to palpate pedal pulses and finds the client to be in atrial fibrillation. Which test will the practitioner order to find the source of the emboli?

Echocardiogram

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.

The nurse is reviewing laboratory results for a client who is experiencing angina. Which finding might be expected in a client with dyslipidemia?

Elevated total cholesterol

The nurse is caring for a postoperative client in traction. Which activity would be most beneficial for preventing atelectasis in this client?

Encourage the client to cough and breathe deeply several times per hour.

What is the function of the capillaries in the circulatory system?

Exchange gases, nutrients, and wastes

What should the nurse teach the client with peripheral vascular disease and intermittent claudication about exercise?

Exercise can increase blood vessel growth and help to decrease symptoms.

The "cold viruses" are rapidly spread from person to person. Which is considered the greatest source of spread of the cold virus?

Fingers

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

Forced expiratory volume

The nurse is teaching a class on reduction of cardiovascular disease. Which action/activity 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

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

Grunting during expiration

A 50-year-old man is having routine blood work done as part of his yearly physical. The doctor informs him that his good cholesterol is low. To which form of cholesterol is the doctor referring?

HDL

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 aspect of hyperlipidemia would the physician most likely take into account when teaching the client?

HDL cholesterol is often characterized as being beneficial to health.

What is the most important factor in myocardial oxygen demand?

Heart rate

Which intervention by the client will decrease overall cardiovascular risk?

Higher levels of fitness and exercise

Which enzyme has a powerful vasodilator effect on arterioles and increases capillary permeability?

Histamine, allowing leakage of both fluid and plasma proteins into the tissues

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

Ventilation is driven by which alteration in arterial blood?

Increased PCO2

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 client is disappointed to learn that he or she has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which age-related change predisposes older adults to the development of heart failure?

Increased vascular stiffness

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.

Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity?

Inherent spontaneous action-potential

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

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

Inspiratory stridor and barking cough

Respiratory sinus dysrhythmia is considered a more optimal rhythm than a rhythm where all RR intervals are equal. In respiratory sinus dysrhythmia, what is the variation in cardiac cycles related to?

Intrathoracic pressure changes that occur with respiration

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

LDL level

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 reason?

Loss of diaphragmatic function

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 1 year ago. What does the nurse suspect is the problem?

Lymphedema

Which related circulatory complication can result from surgical treatment for metastatic breast cancer?

Lymphedema in the affected arm

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

P wave

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

Macrophages

Sick sinus syndrome is suspected in the case of a child who is postoperative following cardiac surgery. Which nursing action is most appropriate?

Monitor the child's ECG for bradycardia.

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

Nosocomial pneumonia

Which factor is the primary factor of local control of blood flow?

Nutritional needs of the tissue involved

A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged, resulting in a pulmonary embolism. Which type 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 client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250 mL of fluid in the pericardial cavity. Which disease should the nurse suspect this client is suffering?

Pericardial effusion

Pain is an expected assessment finding in clients who have which lung disease?

Pleuritis

Persons with hyperaldosteronism will exhibit hypokalemia as aldosterone stimulates renal sodium for potassium exchange.

Potassium sparing diuretics such as spironolactone will inhibit this action of aldosterone and will increase sodium excretion and mitigate the loss of potassium.

Persons with hypertension secondary to hyperaldosteronism may be treated with which medication?

Potassium-sparing diuretics

What is the function of the right ventricle?

Pumps blood to the lungs

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

An intensive care nurse caring for a client who is diagnosed with an anterior wall myocardial infarction (MI) notes frequent premature ventricular complexes on the ECG monitor and is concerned the client could develop a lethal dysrhythmia if one of the premature ventricular complexes fires on which phase of the cardiac action potential?

Relative refractory period ends

A client has presented to the emergency department in distress and is being rapidly assessed by the care team. Which assessment finding would prompt the team to consider the possibility of acute heart failure?

Respiratory distress with audible crackles

Which characteristic of the lungs of infants and small children creates an increased risk of respiratory disorders?

Smaller airways create a susceptibility to changes in airway resistance and airflow.

Which type of lung receptor monitors for lung inflation?

Stretch

What does it mean when a client is in second-degree atrioventricular block and there is a relationship between the P waves and the QRS complex resulting in recurring PR intervals?

The association of P waves and QRS complexes is not random.

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

Which type of pacing involves the placement of large patch electrodes on the anterior and posterior chest wall that can be connected by a cable to an external pulse generator?

Transcutaneous

A client had a tuberculin skin test (TST) performed as part of the immigration process and is surprised that the results are positive. How should the nurse best interpret this result?

The client was exposed to the tubercle bacillus at an indefinite point in the past.

A respiratory therapist is describing the characteristics of the oxygen-hemoglobin dissociation curve to a group of nurses caring for some respiratory clients. The respiratory therapist is describing what will happen to a client's oxygen saturation level if the partial pressure of oxygen decreases from 100 to 95 mm Hg. What will happen if this occurs?

The client will experience a negligible decrease in oxygen saturation.

A 32-year-old client has had a positive reaction to a tuberculin skin test and the duration of exposure is unknown. Which education will the nurse provide based on the most likely treatment course for this client?

The client will need education about the administration of isoniazid and the importance of taking it as prescribed.

A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis (TB) and has subsequently developed latent tuberculosis infection. Which statement is accurate regarding this nurse?

The nurse is likely asymptomatic.

The onset of STEMI involves abrupt and significant chest pain.

The pain typically is severe, often described as being constricting, suffocating, and crushing.

The diaphragm is the primary muscle of respiration and is essential to ventilation.

The phrenic nerve, which exits the spinal cord between C3 and C5, stimulates the diaphragm to contract, increasing the space in the chest cavity and thus causing a decrease in the intrathoracic pressure, allowing air to flow into the lungs.

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.

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.

Arterial circulation exerts much greater pressure than the pressure on the venous side of the circulation

The venous side contains approximately two-thirds of the blood

In which atrioventricular (AV) conduction disorder does the link between the atria and ventricles get lost, resulting in atrial and ventricular depolarization being controlled by separate pacemakers?

Third-degree AV block

An older adult client who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which treatment modality is most likely to resolve the client's most recent health problem?

Thoracentesis

What is the function of the mucociliary blanket that lines the conducting airways?

To remove foreign materials

Which serum biomarker is highly specific for myocardial tissue?

Troponin

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 client presents with uncharacteristic chest pain, and his ECG reveals T-wave elevation. This finding suggests an abnormality with which aspect of the cardiac cycle?

Ventricular repolarization

The innermost layer is the tunica intima, which consists of

a single layer of flattened endothelial cells.

Signs and symptoms associated with impending anaphylactic shock include

abdominal cramps; apprehension; warm or burning sensation of the skin; itching; urticaria (i.e., hives); coughing; choking; wheezing; chest tightness; and difficulty in breathing

expiratory reserve volume

about 1100 mL

inspiratory reserve volume

about 3000 mL

vital capacity

about 4600 mL

Pericardial effusion is caused by

accumulation of fluid and can lead to cardiac tamponade

Which intervention will the nurse prioritize for the medical management of a client with a dissecting aortic aneurysm?

administration of vasodilators and beta-adrenergic blocking medications (beta-blockers)

J receptors

are thought to sense lung congestion.

Class I drugs act by

blocking the fast sodium channels. These drugs affect impulse conduction, excitability, and automaticity to various degrees.

Systolic blood pressure between 120 and 129 mm Hg is classified as

elevated

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

loss of intrapleural negative pressure.

Involvement of lymphatic structures by malignant tumors and removal of lymph nodes at the time of cancer surgery are common causes of

lymphedema

A client with coccidioidomycosis has developed a severe headache with neck stiffness, has a fever, and states feeling very ill. Which complication does the nurse prioritize investigating, because it is the most common cause of death from coccidioidomycosis?

meningitis

In turbulent flow, the laminar stream is disrupted and the flow becomes

mixed, moving radially (crosswise) and axially (lengthwise)

119 mm Hg or lower is classified as

normal

The arterial side of the circulation contains approximately

one-sixth of the blood volume.

The presentation of acute arterial embolism is often described as that of the seven Ps

pistol shot (acute onset), pallor, polar (cold), pulselessness, pain, paresthesia, and paralysis.

irritant receptors

protect against the damaging effects of toxic inhalants;

heart

pumps blood

Which client is showing signs of chronic hypoxemia? A client who is:

restless, has clubbed fingers, and frequently drops items.

A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF (40°C) 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 client most likely is experiencing which type of shock?

septic

Clients who have been bedridden for a long time likely will experience:

shallow, quiet breathing, which impairs the spreading of surfactant.

An individual has sensitivity to perfumes and experiences shortness of breath when exposed to them. This occurs because:

stimulation of irritant receptors causes bronchoconstriction.

An expectant mother of twins has been told there is a strong chance that she will go into labor early and her babies will be premature. In order to increase the chances of having healthy infants, she is given a dose of steroids to stimulate the production of surfactant in the infants' lungs. Surfactant is important for survival of the babies because it reduces:

surface tension of the respiratory membrane.

The right atrium receives blood returning to the heart from the

system circulation

The left ventricle pumps blood into the

systemic circulation

In a normally functioning heart the rate is controlled by

the sinoatrial (SA) node

The heart's atrioventricular valves are

tricuspid and the mitral

Which blood vessel layer is made primarily of muscle?

tunica media (middle layer) of a vessel

Anaphylactic shock is directly associated with:

type I hypersensitivity response

Elevated renin will increase levels of angiotensin II and aldosterone, resulting in

vasoconstriction and sodium and water retention

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

Cor pulmonale

A client is diagnosed with pneumoconiosis. Which aspect of the client's history is most likely the cause of this diagnosis?

Worked in a coal mine for 20 years

phase 0 through part of phase 3 are known as the

absolute refractory phase, when no electrical stimuli can cause another action potential - This period is very long in cardiac muscle conduction as opposed to skeletal muscle to prevent dysrhythmias.

Pericardial effusion refers to the

accumulation of fluid in the pericardial cavity, usually as a result of an inflammatory or infectious process

Congestion of the gastrointestinal tract is usually characteristic of

advanced heart failure

The nurse knows that which of the following would put a client 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

Vascular smooth muscle cells produce vasoconstriction or dilation of blood vessels. Which local tissue factors are correlated with smooth muscle contraction and relaxation?

- lack of oxygen - increased hydrogen ion concentrations - excess carbon dioxide

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

The nurse is assessing a client's respiratory status for lung expansion and airway resistance. Which type of lung receptors respond to changes in pressure occurring in the walls of the airways?

Stretch receptors

Myocardial oxygen supply is determined by

the coronary arteries and capillary inflow, and the ability of hemoglobin to transport and deliver oxygen to the heart muscle

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 that caused an interruption in:

ventilation.

the venous system

collects deoxygenated blood from the tissues and returns it to the heart

Pericardial effusion can lead to a condition called cardiac tamponade in which there is compression of the heart

compression of the heart

A client with chronic renal failure secondary to diabetes has just been diagnosed with secondary hypertension. This increase in blood pressure is likely caused by which physiologic factor?

Activation of the renin-angiotensin-aldosterone mechanism

The heart is a four-chambered pump. Which chamber of the heart pumps blood into the systemic circulation?

left ventricle

A newborn is diagnosed with Tetralogy of Fallot. Prior to surgery, which abnormality should be corrected to prevent a stroke?

Iron deficiency anemia

A nurse is instructing a class for people with newly diagnosed asthma to encourage healthy lifestyle 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

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 of surfactant

Neural control of the blood pressure is related to the

integration and modulation of autonomic nervous system (ANS) response

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

laminar

Substernal pain that radiates to the

left arm, neck, or jaw is common, although it may be experienced in other areas of the chest and back.

The right ventricle pumps blood to

the lungs

The arterial chemoreceptors are cells that monitor

the oxygen, carbon dioxide, and hydrogen ion content of the blood

Preeclampsia-eclampsia is defined as an elevation in blood pressure

(systolic >140 mm Hg or diastolic >90 mm Hg)

Which 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 (39.2°C) - A client with COPD and pneumonia who has a blood gas pH level of 7.31 - A client in renal failure with an admitting hemoglobin level of 8.0 mg/dL (80 g/L)

A client has just been diagnosed with hypercholesterolemia and is asking what treatment will be needed. About which topics should the nurse educate the client?

- smoking cessation - dietary measures to reduce LDL levels - weight reduction if overweight

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

500 mL

A client is seen in the emergency department complaining of chest discomfort, productive cough, and a fever of over 101°F (38.3°C) for 3 days. The nurse performs an electrocardiogram and observes a rate of 110 beats per minute (bpm) with a normal P wave and a PR interval of 0.12 second preceding each QRS complex. What does the nurse determine the rhythm to be?

Sinus tachycardia

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

The outermost layer of a vessel is called the tunica externa (or tunica adventitia) and is composed of

loosely woven collagen fibers

Diagnostic testing has resulted in a diagnosis of small cell lung cancer (SCLC) in an older adult client. When exploring the etiology of the client's disease, what assessment question is most relevant?

"Have you ever been a smoker?"

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.

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

right-sided heart failure