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16. Which of the following types of lung cancer is associated with the best prognosis in the majority of patients? A) Small cell lung cancer B) Adenocarcinoma C) Squamous cell carcinoma D) Large cell carcinoma
C
21. Implantation of a pacemaker is most likely to benefit a client with which of the following cardiomyopathies? A) Myocarditis B) Takotsubo cardiomyopathy C) Dilated cardiomyopathy (DCM) D) Primary restrictive cardiomyopathy
C
16. An 86-year-old male client is disappointed to learn that he has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which of the following age-related changes predisposes older adults to developing heart failure? A) Increased vascular stiffness B) Orthostatic hypotension C) Increased cardiac contractility D) Loss of action potential
A
1. Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by: A) fixed coronary obstruction. B) increased collateral circulation. C) intermittent vessel vasospasms. D) excessive endothelial relaxing factors.
A
1. The "cold viruses" are rapidly spread from person to person. The greatest source of spread is: A) Fingers B) Sneezing C) Plastic toys D) Eye mucosa
A
1. The plaques in a client's coronary arteries are plentiful, and most have small- to moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of the following diagnoses? A) Stable angina B) Non-ST-segment elevation MI C) ST-segment elevation MI D) Unstable angina
A
10. A common symptom of the ischemia associated with gastrointestinal redistribution of blood flow is: A) gastric bleeding. B) nausea and vomiting. C) irritable bowel syndrome. D) copious high volume diarrhea.
A
10. The cold viruses are rapidly spread from person to person. The greatest source of spread is: A) fingers. B) sneezing. C) plastic toys. D) eye mucosa.
A
10. The common results of respiratory failure are hypoxemia and: A) hypercapnia. B) bradycardia. C) vasoconstriction. D) pulmonary emboli.
A
10. An IV drug abuser has been diagnosed with infective endocarditis. He is in the emergency department reporting increasing shortness of breath, rapid breathing, chest pain that worsens with breathing, and coughing up blood. The health care provider recognizes this may be caused by: A) Vegetative emboli traveling in the blood stream to the lungs B) Blood clots in the left ventricle traveling through the aorta C) Microemboli being developed in the carotids by Staphylococcus epidermidis D) Infarction of the tissue surrounding the endocardium of the heart
A
10. While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which of the following physiologic processes? A) Peripheral vascular resistance B) Electrical impulses in the heart C) Release of stress hormones D) Rigidity of the ventricular walls
A
10. While teaching a client with new-onset right-sided heart failure, the nurse should educate the client to monitor for fluid accumulation by: A) Weighing every day at the same time with same type of clothing B) Measuring all of the client's urine output daily to check for a decrease in output C) Listening to the breath sound with a stethoscope every morning D) Take blood pressure daily and call doctor if it is decreased
A
8. The most common causes of left-sided heart failure include: A) Acute myocardial infarction B) Chronic pulmonary disease C) Impaired renal blood flow D) Tricuspid valve regurgitation
A
11. A patient has entered hypovolemic shock after massive blood loss in a car accident. Many of the patients peripheral blood vessels have consequently collapsed. How does the Laplace law account for this pathophysiologic phenomenon? A) Blood pressure is no longer able to overcome vessel wall tension. B) Decreasing vessel radii have caused a decrease in blood pressure. C) Wall thickness of small vessels has decreased due to hypotension. D) Decreases in wall tension and blood pressure have caused a sudden increase in vessel radii.
A
11. A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis and has subsequently developed latent tuberculosis infection. Which of the following is true of this nurse? A) The nurse is likely asymptomatic. B) The nurse is now immune to more severe tuberculosis infection. C) The nurse can spread tuberculosis to others. D) The nurse has active tuberculosis infection.
A
12. An elderly patient who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which of the following treatment modalities is most likely to resolve the patients most recent health problem? A) Thoracentesis B) Supplementary oxygen therapy C) Administration of corticosteroids D) Administration of bronchodilators
A
12. The plaques in a patients coronary arteries are plentiful and most have small- to moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of the following diagnoses? A) Stable angina B) Non-ST-segment elevation MI C) ST-Segment elevation MI D) Unstable angina
A
13. Assessment of an elderly female patient reveals the presence of bilateral pitting edema of the patients feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the patients lungs reveals clear air entry to bases, and the patients oxygen saturation level is 93% and vital signs are within reference ranges. What is this patients most likely health problem? A) Right-sided heart failure B) Left-sided heart failure C) Cardiogenic shock D) Cor pulmonale
A
13. Which of the following individuals should be prioritized for receiving a seasonal influenza vaccination? A) An 81-year-old resident of a long-term care facility B) A 19-year-old man who was admitted to a hospital for an appendectomy C) A neonate who was born in a busy, inner-city hospital in late October D) An 86-year-old patient whose flu symptoms have required hospitalization
A
13. Which of the following is a nonmodifiable risk factor for the development of primary hypertension? A) African American race B) High salt intake C) Male gender D) Obesity
A
14. Coronary artery bypass grafting (CABG) is a relevant treatment modality for which of the following disorders of cardiac function? A) Atherosclerosis with history of MI B) Pericardial effusion and cardiac tamponade C) Dilated cardiomyopathies D) Aortic valve regurgitation and aortic stenosis
A
14. A 51-year-old man has been diagnosed with chronic bronchitis after a long history of recurrent coughing. Which of the man's following statements demonstrates a sound understanding of his new diagnosis? A) "If I had quit smoking earlier than I did, I think I could have avoided getting bronchitis." B) "I'm pretty sure that I first caught bronchitis from the person who has the cubicle next to mine at work." C) "I read on the Internet that I might have got bronchitis because I was born with an enzyme deficiency." D) "I think that I probably could have prevented this if I had got in the habit of exercising more when I was younger."
A
14. An elderly female client who reports increasing fatigue has been diagnosed with aortic stenosis, a disease that her primary care provider believes may have been long-standing. Which of the following compensatory mechanisms has most likely maintained the woman's ejection fraction until recently? A) Left ventricular hypertrophy B) Increased blood pressure C) Increased heart rate and stroke volume D) Aortic dilation
A
15. A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborneMycobacterium tuberculosis bacteria and has subsequently developed latent tuberculosis infection. Which of the following is true of this nurse? A) The nurse is likely asymptomatic. B) The nurse is now immune to more severe tuberculosis infection. C) The nurse can spread tuberculosis to others. D) The nurse has active tuberculosis infection.
A
15. 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 of the following possible diagnoses? A) Small cell lung cancer due to smoking history B) Tuberculosis due to long period of coughing C) Pulmonary embolism due to blood in sputum D) Pneumothorax related to chronic lung infection weakening the alveoli
A
15. Preload represents the volume work of the heart and is largely determined by: A) Venous blood return B) Vascular resistance C) Force of contraction D) Ventricular emptying
A
16. A 51-year-old man has been diagnosed with chronic bronchitis after a long history of recurrent coughing. Which of the mans following statements demonstrates a sound understanding of his new diagnosis? A) If I had quit smoking earlier than I did, I think I could have avoided getting bronchitis. B) Im pretty sure that I first caught bronchitis from the person who has the cubicle next to mine at work. C) I read on the Internet that I might have got bronchitis because I was born with an enzyme deficiency. D) I think that I probably could have prevented this if I had got in the habit of exercising more when I was younger.
A
16. A patients primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen to treat his primary hypertension. How does this diuretic achieve its therapeutic effect? A) By decreasing vascular volume by increasing sodium and water excretion B) By blocking the release of antidiuretic hormone from the posterior pituitary C) By inhibiting the conversion of angiotensin I to angiotensin II. D) By inhibiting the movement of calcium into arterial smooth muscle cells
A
16. Electrical burns over a large surface area of a patients body have resulted in hypovolemic shock after the loss of large amounts of blood and plasma. Which of the following mechanisms is the patients body likely to implement to compensate for this loss of fluid? A) Increased heart rate B) Vasodilation C) Diuresis D) Inhibition of ADH
A
17. A 29-year-old woman who considers herself active and health conscious is surprised to have been diagnosed with preeclampsia-eclampsia in her second trimester. What should her care provider teach her about this change in her health status? A) We dont really understand why some women get high blood pressure when theyre pregnant. B) This is likely a result of your nervous system getting overstimulated by pregnancy. C) Hypertension is a common result of all the hormonal changes that happen during pregnancy. D) Even though youre a healthy person, it could be that you have an underlying heart condition.
A
17. Which of the following individuals is experiencing a disorder of ventilation that has a restrictive rather than obstructive etiology? A) A 30-year-old African American man who has been diagnosed with sarcoidosis B) An infant whose routine screening is suggestive of cystic fibrosis C) An elderly, lifelong smoker who has been admitted to hospital with emphysema D) A 16-year-old girl who must limit her activity to prevent asthmatic attacks
A
17. A client's primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen to treat his primary hypertension. How does this agent achieve its therapeutic effect? A) By decreasing vascular volume by increasing sodium and water excretion B) By blocking the release of antidiuretic hormone from the posterior pituitary C) By inhibiting the conversion of angiotensin I to angiotensin II D) By inhibiting the movement of calcium into arterial smooth muscle cells
A
18. A patient who lives with a diagnosis of angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experienced while mowing his lawn. This drug has resulted in a release of nitric oxide, which will have what effect? A) Smooth muscle relaxation of vessels B) Decreased heart rate and increased stroke volume C) Increased preload D) Reduction of cardiac refractory periods
A
18. An elderly female patient with complaints of increasing fatigue has been diagnosed with aortic stenosis, a disease which her primary care provider believes may have been long-standing. Which of the following compensatory mechanisms has most likely maintained the womans ejection fraction until recently? A) Left ventricular hypertrophy B) Increased blood pressure C) Increased heart rate and stroke volume D) Aortic dilation
A
18. A 29-year-old woman who considers herself active and health conscious is surprised to have been diagnosed with preeclampsia-eclampsia in her second trimester. What should her care provider teach her about this change in her health status? A) "We don't really understand why some women get high blood pressure when they're pregnant." B) "This is likely a result of your nervous system getting overstimulated by pregnancy." C) "Hypertension is a common result of all the hormonal changes that happen during pregnancy." D) "Even though you're a healthy person, it could be that you have an underlying heart condition."
A
18. Which of the following individuals is experiencing an immunologic lung disorder affecting ventilation that has caused the formation of a granuloma on chest x-ray? A) A 30-year-old African American man who has been diagnosed with sarcoidosis B) An infant whose routine screening is suggestive of cystic fibrosis C) An elderly, lifelong smoker who has been admitted to hospital with emphysema exacerbation D) A 16-year-old girl who must limit her physical activity to prevent the onset of acute asthmatic attacks
A
19. A patient is receiving homecare for the treatment of a wound on the inside of her lower leg which is 3 cm in diameter with a yellow wound bed and clear exudate. Assessment of the patients legs reveals edema and a darkened pigmentation over the ankles and shins of both legs. What is this patients most likely diagnosis? A) Chronic venous insufficiency B) Deep vein thrombosis C) Varicose veins D) Peripheral arterial disease
A
19. An 86-year-old male patient is disappointed to learn that he has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which of the following age-related changes predisposes older adults to developing heart failure? A) Increased vascular stiffness B) Orthostatic hypotension C) Increased cardiac contractility D) Loss of action potential
A
19. Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma? A) Pet dander B) Cold weather C) Stress D) Respiratory tract infections
A
2. A major cause of secondary hyperlipoproteinemia is _______, which increases the production of VLDL and conversion to LDL. A) high-calorie diet B) diabetes mellitus C) bile-binding resin D) cholesterol ingestion
A
2. An elderly client who has been restricted to bed by numerous comorbidities for several weeks has been diagnosed with a large pleural effusion. Which of the following treatment modalities is most likely to resolve the client's most recent health problem? A) Thoracentesis B) Supplementary oxygen therapy C) Administration of corticosteroids D) Administration of bronchodilators
A
2. Which of the following would be considered a major cause of secondary hyperlipoproteinemia since it increases the production of VLDL and conversion to LDL? A) High-calorie diet B) Diabetes mellitus C) Bile-binding resin D) Cholesterol ingestion
A
20. A 6-month-old infant has been hospitalized with acute bronchiolitis. Which of the following treatments should be prioritized in the infants care? A) Supplementary oxygen therapy B) Intravenous antibiotics C) Transfusion of fresh frozen plasma D) Tracheotomy
A
20. Most respiratory disorders in infants produce a decrease in: A) Lung compliance B) Airway resistance C) Oxygen demand D) Respiratory rate
A
21. A client who lives with angina pectoris has taken a sublingual dose of nitroglycerin to treat the chest pain he experiences while mowing his lawn. This drug facilitates release of nitric oxide, which will have what physiologic effect? A) Smooth muscle relaxation of vessels B) Decreased heart rate and increased stroke volume C) Increased preload D) Reduction of cardiac refractory periods
A
8. Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by: A) Fixed coronary obstruction B) Increased collateral circulation C) Intermittent vessel vasospasms D) Excessive endothelial relaxing factors
A
22. A young, male child is born with severe respiratory failure. Over the course of months, the parents note his body looks swollen. They ask, "Is our baby's kidneys not working right? Why is he so swollen?" The nurse bases his or her reply on which of the following physiological principles? A) "The right side of his heart (cor pulmonale) is not pumping effectively. Blood is backlogging in his body, which is why he is so swollen." B) "We just need to call the physician and ask him to give you a prescription for more water pills." C) "Once we get his oxygenation level back to normal, then maybe his kidneys will receive enough oxygenated blood to filter better." D) "This happens when he has so many secretions in his lungs. Maybe we should try some expectorant to thin his secretions so he can cough them out."
A
23. A client is receiving home care for the treatment of a wound on the inside of her lower leg that is 3 cm in diameter with a yellow wound bed and clear exudate. Assessment of the client's legs reveals edema and a darkened pigmentation over the ankles and shins of both legs. What is this client's most likely diagnosis? A) Chronic venous insufficiency B) Deep vein thrombosis C) Varicose veins D) Peripheral arterial disease
A
24. A 6-month-old infant has been hospitalized with acute bronchiolitis. Which of the following treatments should be prioritized in the infant's care? A) Supplementary oxygen therapy B) Intravenous antibiotics C) Transfusion of fresh frozen plasma D) Tracheotomy
A
24. Which of the following clients is at risk for developing acute respiratory failure? A) A middle-aged male diagnosed with amyotrophic lateral sclerosis (ALS) who has pneumonia with low O2 saturation B) An elderly female living in senior housing who has been exposed to a "cold" while her grandchildren visited C) A teenager in a high school that has had an increase in student absences due to an outbreak of strep throat D) A toddler in daycare who has been sharing toys with peers before the staff could sanitize properly
A
25. In the ICU setting, clients who develop shock need thorough head-to-toe assessments. Which of the following clinical manifestations would alert the health care provider that the client may be developing ischemia associated with gastrointestinal redistribution of blood flow? A) Gastric bleeding B) Nausea and vomiting C) Irritable bowel syndrome D) Copious high-volume diarrhea
A
3. Atelectasis is most commonly caused by: A) airway obstruction. B) pulmonary embolism. C) inflammation of the pleura. D) chronic forceful coughing.
A
3. Legionnaire disease is a form of bronchopneumonia caused by an organism frequently found in: A) warm, standing water. B) public restrooms. C) fermenting yogurt. D) potted plant dirt.
A
3. One of the principal mechanisms by which the heart compensates for increased workload is: A) myocardial hypertrophy. B) sodium and water retention. C) endothelin vasoconstrictors. D) ventricular wall tension increase.
A
3. A client has entered hypovolemic shock after massive blood loss in a car accident. Many of the client's peripheral blood vessels have consequently collapsed. How does the Laplace law account for this pathophysiologic phenomenon? A) Blood pressure is no longer able to overcome vessel wall tension. B) Decreasing vessel radii has caused a decrease in blood pressure. C) Wall thickness of small vessels has decreased due to hypotension. D) Decreases in wall tension and blood pressure have caused a sudden increase in vessel radii.
A
3. One of the principal mechanisms by which the heart compensates for increased workload is: A) Myocardial hypertrophy B) Sodium and water retention C) Endothelin vasoconstrictors D) Ventricular wall tension increase
A
4. Acute onset bronchial asthma causes wheezing and breathlessness as a result of: A) airway inflammation. B) alveolar collapse. C) compression atelectasis. D) pulmonary hypertension.
A
4. In right-sided heart failure, peripheral edema is evidenced by: A) weight gain. B) copious urination. C) shortness of breath. D) decreased blood pressure.
A
5. Emphysema is characterized by hyperinflation of the lungs that produces increased: A) total lung capacity. B) alveolar wall thickness. C) a1-antitrypsin enzyme. D) submucosal gland hypertrophy.
A
5. People infected with HIV and tuberculosis lack a hypersensitivity response to the tuberculin test as a result of: A) inherent anergy. B) host cell depletion. C) poor lung perfusion. D) boosting phenomenon.
A
5. The most common causes of left-sided heart failure include: A) acute myocardial infarction. B) chronic pulmonary disease. C) impaired renal blood flow. D) tricuspid valve regurgitation.
A
5. Which of the following individuals should be prioritized for receiving a seasonal influenza vaccination? A) An 81-year-old resident of a long-term care facility B) A 19-year-old man who was admitted to a hospital for an appendectomy C) A neonate who was born in a busy, inner-city hospital in late October D) An 86-year-old client whose flu symptoms have required hospitalization
A
6. Which of the four categories of bronchogenic carcinoma has the greatest association with tobacco smoking and tends to metastasize to the brain? A) Small cell B) Large cell C) Squamous cell D) Adenocarcinoma
A
6. The nurse would anticipate that which of the following clients would be considered a good candidate for coronary artery bypass grafting (CABG)? A) A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation B) A 24-year-old auto accident client diagnosed with pericardial effusion and cardiac tamponade C) A 87-year-old client admitted with uncontrolled dilated cardiomyopathy D) A 78-year-old client admitted with increasing fatigue related to aortic stenosis
A
7. With bronchiectasis, persistent airway obstruction and chronic infection results in bronchial: A) dilation. B) rupture. C) infarction. D) thickening.
A
8. Long-term autoregulation of local blood flow in the microcirculation is mediated by: A) collateral circulation. B) arteriovenous shunting. C) autonomic nervous system. D) metabolic needs of the tissues.
A
8. Most respiratory disorders in infants produce a decrease in: A) lung compliance. B) airway resistance. C) oxygen demand. D) respiratory rate.
A
9. Assessment of an elderly female client reveals the presence of bilateral pitting edema of the client's feet and ankles and pedal pulses that are difficult to palpate. Auscultation of the client's lungs reveals clear air entry to bases, and the client's oxygen saturation level is 93%, and vital signs are within reference ranges. What is this client's most likely health problem? A) Right-sided heart failure B) Pericarditis C) Cardiogenic shock D) Cor pulmonale
A
9. Which of the following is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma? A) Pet dander B) Cold weather C) Stress D) Respiratory tract infections
A
Preload represents the volume work of the heart and is largely determined by: A) venous blood return. B) vascular resistance. C) force of contraction. D) ventricular emptying.
A
The difference between the end-diastolic and end-systolic volumes is the: A) stroke volume. B) cardiac output. C) ejection fraction. D) cardiac reserve.
A
Turbulent blood flow can be caused by a number of factors, including: A) increased velocity. B) short vessel length. C) high blood viscosity. D) layering of blood cells.
A
Which of the following is a nonmodifiable risk factor for the development of primary hypertension? A) African American race B) High salt intake C) Male gender D) Obesity
A
10. The parasympathetic nervous system causes a slowing of the heart rate by increasing: A) norepinephrine. B) vessel constriction. C) vagus nerve activity. D) smooth muscle tone.
C
22. Which of the following clients would be at high risk for developing primary varicose veins? Select all that apply. A) A 47-year-old waitress who works 12-hour shifts three or four times/week B) A morbidly obese (>100 pounds overweight) male who works behind the counter of a convenience store 10 hours/day, 5 days/week C) A 56-year-old male who has been immobile due to back surgery and has developed a deep vein thrombosis D) A Marathon runner who has completed three marathons in the past 3 months E) A new peritoneal dialysis client who has been utilizing a home machine and performing dialysis every evening beginning at 8 PM
A,B
8. Which of the following clients at the clinic should be encouraged to receive the pneumococcal polysaccharide vaccine (PPSV23)? A client: Select all that apply. A) Who is 65 years old with chronic asthma B) With a smoking history C) Who is a young adult with HIV-positive results D) Who is school-aged and has received a liver transplant E) Who is a teenager with history of kidney disease
A,B
13. Which of the following diagnostic/assessment findings would been seen in a client with worsening mitral valve stenosis? Select all that apply. A) Low-pitched diastolic murmur that is increasing in duration B) Sharp elevation in left atrial pressure C) Decreased cardiac output D) Severe elevation in left ventricular end-diastolic pressure E) Left ventricle increases its stroke volume
A,B,C
14. A client with newly diagnosed squamous cell carcinoma of the lung asks, "So how do we treat this cancer?" Which response from the health care provider is most accurate? Select all that apply. A) Surgery to remove tumor B) Radiation therapy C) Chemotherapy D) Stem cell transplant E) Monoclonal antibody
A,B,C
20. A client is admitted with dilated cardiomyopathy with left ventricular dysfunction. The nurse should assess for which of the following clinical manifestations? Select all that apply. A) Dyspnea B) Orthopnea C) Extreme fatigue with activity D) Excess abdominal fluid E) Fainting
A,B,C
23. When educating the parents of a cyanotic infant diagnosed with of tetralogy of Fallot, the nurse will include which of the following statements related to the physiological abnormalities? The infant has: Select all that apply. A) A hole in the ventricular septal B) A small, narrow pulmonary outflow channel C) A large, thick, right ventricular wall D) A very small, narrow aorta E) The pulmonary artery arises from the left ventricle
A,B,C
25. A 2-year-old child is admitted to pediatric unit with bronchiolitis. The nurse calls the physician fearing the child is going into respiratory failure based on which of the following assessment findings? Select all that apply. A) Increased respiratory rate to 44 breaths/minute B) Substernal retractions becoming more pronounced C) New-onset expiratory grunting D) Productive cough with white secretions E) Faint wheezes noted in the posterior lung base
A,B,C
19. Which of the following children may be considered high risk for developing hypertension? Select all that apply. A) Diagnosed with coarctation of the aorta as an infant B) Recent scan showing a pheochromocytoma C) Has a history of epilepsy with weekly seizures D) Takes cyclosporine daily since a kidney transplant E) Has a history of frequent sinus infections treated with antibiotics
A,B,D
7. A client with a history of heart failure and COPD (caused by 60 pack/year smoking) presents to the clinic with the following complaints: auscultation of breath sounds reveal absent/diminished breath sounds in the right lower lobe. Which other manifestations lead the health care provider to suspect the client may have developed atelectasis? Select all that apply. A) Respiratory rate—32; pulse rate—122 beats/minute. B) "Having a hard time catching my breath." C) "Seems like I'm not making much water (decreased urine production)." D) Using accessory muscles to help him breathe. E) Copious amounts of thick, green sputum.
A,B,D
15. An elderly client is admitted with the diagnosis of severe aortic regurgitation. Which of the following client reports support this diagnosis? Select all that apply. A) Exertional dyspnea B) Orthopnea C) Frequent angina D) Paroxysmal nocturnal dyspnea E) Palpitations
A,B,D,E
11. The shortness of breath and cyanosis that occur in clients experiencing acute heart failure syndrome are primarily caused by: Select all that apply. A) Accumulation of fluid in the alveoli and airways B) Lung stiffness C) Worsening renal failure D) Myocardial muscle necrosis E) Impaired gas exchange
A,B,E
16. Which of the following would be considered a clinical manifestation of acute pericarditis? Select all that apply. A) Sharp, abrupt onset of chest pain that radiates to the neck B) Pericardial friction rub C) Narrowed pulse pressure D) Muffled heart sounds E) Abnormal ECG results
A,B,E
21. A 6-hour-old newborn develops a critical respiratory problem and is rushed to the ICU. The ICU nurses suspect the infant has respiratory distress syndrome (RDS) based on which findings? Select all that apply. A) Bluish discoloration of the skin and mucous membranes (central cyanosis) B) Substernal retractions with each breathe C) Periorbital edema D) Clubbed fingers E) Expiratory grunting
A,B,E
9. 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 of the following manifestations are characteristic of Legionnaire pneumonia? Select all that apply. A) Temperature of 103.5°, pulse 80 B) "Talking but not making a lot of sense" (confusion) C) Decreased abdominal bowel sounds D) Productive cough with thick, yellow secretions E) Chest x-ray that reveals areas of consolidation suggestive of pneumonia
A,B,E
13. While lecturing on COPD, the instructor mentions emphysema. The instructor asks the students, "If the client is a smoker, explain the physiology behind cellular changes occurring in the lung which allow destruction of the alveoli." Which students have an accurate response? Select all that apply. A) "Antiprotease production and release is not adequate to neutralize the excess protease production." B) "The capillary beds can no longer bring the cells to the lung to fight off the infection since they are blocked by fatty plaque." C) "There is a1-antitrypsin deficiency, so this enzyme can't protect the lung from damage." D) "The alveolar tissue is being digested by enzymes; therefore, they can't grow back to restore normal ventilation."
A,C
16. A nurse runs into an old high school friend after 20 years. She notes her friend continues to smoke after all these years. The friend asks, "Do you think I sound hoarse?" Upon further assessment, the nurse/friend notes her friend has several warning signs of cancer. Which manifestations would lead to this conclusion? Select all that apply. A) "I seem to have some difficulty swallowing food... this is new for me." B) "I seem to have more trouble holding my urine than I use to." C) "Can you feel how large my lymph nodes are on my neck and armpits (axillae)?" D) Pericardial friction rub heard on auscultation. E) Feels subcutaneous emphysema in upper chest area.
A,C
25. A person newly diagnosed with Kawasaki disease in the acute phase will likely have which of the following clinical manifestations? Select all that apply. A) Fever B) Peeling of the skin of the fingers and toes C) Edematous hands and feet D) Bilateral conjunctivitis E) Irritability and lability of mood
A,C,D
12. A toddler seems to have a little "cold" and runny nose. At bedtime, he appears to be OK. A few hours later, parents awaken hearing a "tight" coughing sound. They recognize the child is not breathing well, so they rush to the emergency department. On arrival, the nurses suspect bronchial asthma based on which of the following assessment data? Select all that apply. A) Audible wheezing B) "Crowing sound with inspiration" C) Respiratory rate—44 with prolonged exhalation D) Coughing up blood-tinged sputum E) Sitting upright, leaning forward, and using accessory muscles to breathe
A,C,E
6. At the cellular level, cardiac muscle cells respond to an increase in ventricular volume to the point of overload by: Select all that apply. A) Elongating the cardiac muscle cells B) Thickening of the individual myocytes C) Replicating the myofibrils D) Decreasing the ventricular wall thickness E) Symmetrically widening and lengthening the hypertrophy
A,D
7. From the following clients, who are at high risk for developing heart failure as a result of diastolic dysfunction? Select all that apply. A) A 48-year-old client with uncontrolled hypertension B) A marathon runner with history of chronic bradycardia whose pulse rate is 46 C) A 57-year-old client with history of ischemic heart disease D) A 70-year-old with enlarged left ventricle due to myocardial hypertrophy
A,D
13. Following a dust storm in Arizona, several clients have presented to the clinic complaining of productive cough, fever, and night sweats. The health care provider suspects a fungal infection related to breathing dust. One particular client is critical. They suspect the infection has progressed outside the lung when they observe the client has: Select all that apply. A) Generalized lymph node enlargement B) Urine output decreased to 40 mL/hour C) Requires guaifenesin to cough up sputum D) An enlarged liver via palpation E) Copious bleeding at the site where the lab technician drew some blood
A,D,E
18. Electrical burns over a large surface area of a client's body have resulted in hypovolemic shock after the loss of large amounts of blood and plasma. Following physical assessment, which findings lead the nurse to believe the client's body is compensating for this fluid loss? Select all that apply. A) Increased heart rate B) Vasodilation with warm extremities C) Diuresis with output of 100 mL/hour D) The client complaining of extreme thirst E) Deep, rapid respirations
A,D,E
19. Soon after delivery, the mother grabs the nurses arm and states, "Something's wrong...I can't get my breath." Which of the following assessments lead the nurse to suspect the client has had an amniotic emboli travel to the lungs? Select all that apply. A) BP 90/65; pulse 130, irregular; respiratory rate 35, shallow. B) Intercostal traction noted on inspiration. C) +3 pitting edema in lower extremities. D) Trachea has shifted and is no longer midline. E) Productive cough with blood-streaked sputum.
A,E
17. A teenaged cystic fibrosis client presents to the clinic. The health care provider (HCP) knows that cystic fibrosis (CF) causes severe chronic respiratory disease in children. In addition, the HCP should also focus his or her assessment on which of the other body systems affected by CF? A) Renal B) Pancreatic C) Cardiac D) Central nervous system
B
1. A distinguishing feature of viral influenza is: A) direct contact transmission. B) abrupt-onset, profound malaise. C) constant pounding headache. D) profuse watery nasal discharge.
B
1. In the arterial-venous circulatory system, pressure is inversely related to: A) velocity. B) volume. C) tension. D) viscosity.
B
1. Pleuritic chest pain associated with respiratory movements is usually described as: A) bilateral. B) localized. C) continuous. D) substernal.
B
1. The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output. A) aortic hypertrophy B) compensatory mechanisms C) electrical conductivity D) parasympathetic system
B
1. A client asks, "Why do I have clogged arteries but my neighbor has higher 'bad cholesterol' levels and yet he is just fine?" The health care provider bases the reply on which of the following physiological principles about lipoprotein? A) "Your neighbor probably has higher amounts of good cholesterol (HDL) as well." B) "You more than likely have small, dense type of 'bad cholesterol' (LDL)." C) "Your neighbor has larger 'bad cholesterol' particles that can move into blood vessels but park in joints/tendons." D) "You must have a genetic predisposition to having clogged arteries."
B
1. Upon admission assessment, the nurse hears a murmur located at the fifth intercostal space, midclavicular line. The client asks, "What does that mean?" The nurse will base her answer on which of the following physiologic principles? A) "You have been exposed to an infection that went into your blood stream." B) "You have a heart valve that is diseased." C) "You heart has been pumping your blood so hard, that the pressure has damaged your valves." D) "Your heart has enlarged, so naturally your valves had to enlarge as well."
B
1. When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents: A) Strength of the right ventricular pump to move blood B) The amount of blood the heart pumps each minute C) The amount of blood pumped out of the heart with each beat D) The volume of blood stretching the heart muscle at the end of diastole
B
18. For which of the following types of shock might intravenous antibiotic therapy be indicated? A) Obstructive shock B) Distributive shock C) Cardiogenic shock D) Hypovolemic shock
B
10. When explaining a new diagnosis of complete heart block to a client/family, the nurse should include which of the following statements? A) "This means that your atria are not contracting normally, they are quivering." B) "One consequence of this type of block is a very slow heart rate that limits circulation to the brain." C) "This type of arrhythmia requires defibrillation, which will occur in the cardiac catheter lab later today." D) "It's pretty common for everyone to experience this arrhythmia, especially during times of stress in their lives."
B
11. Which of the following medications helps treat the inflammatory reaction of asthma clients diagnosed with late-phase asthma response? A) Anticholinergic agents B) Systemic corticosteroids C) Long-acting b2-agonists D) Phosphodiesterase inhibitors
B
12. A patient with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the patients increased blood pressure? A) Increased levels of adrenocortical hormones B) Activation of the renin-angiotensin-aldosterone mechanism C) Increased sympathetic stimulation by the autonomic nervous system (ANS) D) Coarctation of the patients aorta
B
12. In the days following a tooth cleaning and root canal, a patient has developed an infection of the thin, three-layered membrane that lines the heart and covers the valves. What is this patients most likely diagnosis? A) Pericarditis B) Endocarditis C) Myocarditis D) Vasculitis
B
12. A client consistently has an elevated systolic BP greater than 150 mm Hg but a diastolic pressure in the 80s. The health care provider should be assessing for which of the following complications? A) Peripheral edema in lower legs from renal disease B) Crackles in bilateral lung bases caused by left-sided heart failure C) Ascites due to liver damage D) Confusion due to atherosclerosis of the carotid arteries
B
12. While administering a tuberculin (TB) skin test, a client who is HIV positive asks, "I heard from my friends, this test may not work on me since I have HIV." The health care provider's best response would be: A) "This test is 99.9% specific, so it will give us an accurate result." B) "Sometimes immunocompromised clients will have negative results if you are unable to mount a normal immune reaction." C) "Most of the time, with HIVpositive clients, we see more false-positive results since you may have a similar infection in your body." D) "If your test comes back positive, we will send a blood test off to a special lab to confirm you really have TB before we start treatment."
B
13. A motor vehicle accident has resulted in a tension pneumothorax for the driver of the car. Which of the following manifestations is associated with tension pneumothorax? A) Audible friction rub over the affected lung B) Mediastinal shift C) Metabolic alkalosis D) Atrial fibrillation
B
13. Which of the following individuals is suffering the effects of acute coronary syndrome (ACS)? A) A patient whose most recent ECG indicates that silent myocardial ischemia has occurred B) A patient who occasionally experiences persistent and severe chest pain when at rest C) A patient who sometimes experiences chest pain when climbing stairs D) A patient who has recently been diagnosed with variant (vasospastic) angina
B
13. A heart failure client has an echocardiogram performed revealing an ejection fraction (EF) of 40%. The nurse knows this EF is below normal and explains to the client: A) "This means you have a lot of pressure built-up inside your heart." B) "This means your heart is not pumping as much blood out of the heart with each beat." C) "You need to increase the amount of exercise you do to get your heart muscle back in shape." D) "Your ventricular muscle is getting too stiff to beat normally."
B
14. A patient has been admitted to a medical unit of a hospital for the treatment of pneumonia that is attributable to S. pneumonia. Which of the following considerations is the priority in this patients treatment? A) Maintaining the patients activities of daily living B) Maintaining the patients airway C) Monitoring and treating the patients pain D) Preventing and treating the patients fever
B
14. A client with a history of heart failure has been referred for an echocardiogram. Results of this diagnostic test reveal the following findings: heart rate 80 beats/minute; end-diastolic volume 120 mL; and end-systolic volume 60 mL. What is this client's ejection fraction? A) 200 mL B) 50% C) 0.80 D) 180 mL
B
15. A client with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the client's increased blood pressure? A) Increased levels of adrenocortical hormones B) Activation of the renin-angiotensin-aldosterone mechanism C) Increased sympathetic stimulation by the autonomic nervous system (ANS) D) Coarctation of the client's aorta
B
15. When evaluating the pulmonary function test results for a COPD client, which one correlates to the mismatch of ventilation and perfusion associated with this diagnosis? A) Forced vital capacity (FVC) is elevated. B) Forced expiratory volume (FEV) is decreased. C) Total lung capacity (TLC) is decreased. D) Marked decrease in residual volume (RV).
B
16. A patient with a history of heart failure has been referred for an echocardiogram. Results of this diagnostic test reveal the following findings: heart rate 80 beats per minute; end-diastolic volume 120 mL; end-systolic volume 60 mL. What is this patients ejection fraction? A) 200 mL B) 50% C) .80 D) 180 mL
B
16. A client with a diagnosis of secondary hypertension has begun to experience signs and symptoms that are consistent with decreased cardiac output. Which of the following determinants of cardiac output is hypertension most likely to affect directly? A) Preload B) Afterload C) Contractility D) Heart rate
B
17. A patient with a diagnosis of secondary hypertension has begun to experience signs and symptoms that are ultimately suggestive of decreased cardiac output. Which of the following factors that determine cardiac output is hypertension likely to affect most directly? A) Preload B) Afterload C) Contractility D) Heart rate
B
18. Which of the following characteristics of the lungs of infants and small children creates an increased risk of respiratory disorders? A) Type II alveoli in children may overproduce surfactant. B) Smaller airways create a susceptibility to changes in airway resistance and airflow. C) The pneumotaxic center in the pons in underdeveloped until 8 years of age. D) There are fewer chemoreceptors in the young medulla.
B
19. In an ICU setting, one assessment that would lead the nurse to suspect shock has resulted in decrease blood flow to vital organs is: A) Warm legs with peripheral vasodilation B) Urine output less than 20 mL/hour C) Blood pressure staying in the 98/72 range for the past hour D) Sleepiness and difficulty to arouse without using painful stimuli
B
19. Which of the following characteristics of the lungs of infants and small children creates an increased risk of respiratory disorders? A) Type II alveoli in children may overproduce surfactant. B) Smaller airways create a susceptibility to changes in airway resistance and airflow. C) The pneumotaxic center in the pons is underdeveloped until 8 years of age. D) There are fewer chemoreceptors in the young medulla.
B
19. Which of the following statements about calcium channel-blocking (CCB) drugs is accurate? A) Since CCB drugs work the a-adrenergic receptors to open the channels, vasoconstriction occurs. B) CCB drugs work on b-adrenergic receptors to close the channels, so vasodilation occurs. C) CCB drugs prevent reabsorption of calcium in the kidneys and therefore can lower serum calcium levels. D) CCB drugs cause smooth muscle contraction, thereby allowing more blood to be stored in veins.
B
2. A common cause of bacterial pneumonia in both community and hospital setting is: A) E. coli B) S. aureus. C) Enterobacter. D) S. pneumoniae.
B
2. A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a life-threatening condition because: A) expired air exits the bleeding wound. B) trapped, inspired air collapses the lung. C) the opposite lung hyperinflates. D) blebs on the lung surface rupture.
B
2. Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a: A) red thrombus. B) large lipid core. C) calcified lesion. D) vessel wall injury.
B
2. Cardiac output is the ________ each minute. A) volume load B) blood pumped C) stroke volume D) force generated
B
2. Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a: A) Red thrombus B) Large lipid core C) Calcified lesion D) Vessel wall injury
B
20. Which of the following factors is the primary governor of the local control of blood flow? A) Action potential B) The nutritional needs of the tissue involved C) Cardiac contractility and preload D) Feedback from arterial baroreceptors and chemoreceptors
B
20. An elderly client newly diagnosed with systolic hypertension asks her health care provider why this happens. The most accurate response would be: A) "Everyone over the age of 50 tends to have their blood pressure creep up over the years." B) "With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer." C) "Your heart has to work harder to pump blood through your vessels as you get older." D) "If you slow down and rest more, your blood pressures will more than likely return to its normal level."
B
20. Following a hypertensive crisis, a client's family asks, "Why are the client's eyes so bloodshot?" The nurse responds that high arterial pressure: A) From straining to have a bowel movement can rupture small vessels in the eyes B) Damages more fragile blood vessels like those in the eyes to the point of rupture C) Can interfere with clotting factor production, so clients bleed more easily D) Cause heart muscle to pump stronger, sending too much blood to small vessels in the eyes
B
23. For which of the following types of shock might intravenous antibiotic therapy be indicated? A) Obstructive shock B) Distributive shock C) Cardiogenic shock D) Hypovolemic shock
B
24. 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: A) "You must have been taking a blood thinner for a long time." B) "You have small channels between some of your arteries, so you can get blood from a patent artery to one severely blocked." C) "You are just a lucky person since most people would have had a massive heart attack by now." D) "With this amount of blockage, your red blood cells get through the vessel one-by-one and supply oxygen to the muscle."
B
3. The most important complication of atherosclerosis is _________, which may cause occlusion of small heart vessels. A) ulceration B) thrombosis C) fatty streaks D) fibrous plaque
B
3. Clients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant: A) Heart murmurs B) ECG changes C) Pulmonary disease D) Pericardial effusion
B
3. Pleuritic chest pain associated with respiratory movements is usually described as: A) Bilateral B) Localized C) Continuous D) Substernal
B
4. A client with heart failure asks, "Why am I taking a 'water pill' when it's my heart that is having a problem?" While educating the client about the Frank-Starling mechanism, which of the following explanations is most appropriate to share? A) "You must be drinking way too many liquids. Your kidneys cannot filter all that you are drinking during the day." B) "Since your heart is not pumping efficiently, the kidneys are getting less blood flow; therefore, the kidneys are holding on to sodium and water." C) "Your heart muscle is overstretched, so it's not able to pump all the blood out. The prescribed 'water pills' help by decreasing your weight." D) "Since your heart function is impaired, the lungs are not able to oxygenate the blood and your kidneys are wearing out."
B
4. A distinguishing feature of viral influenza is: A) Direct contact transmission B) Abrupt-onset, profound malaise C) Constant pounding headache D) Profuse watery nasal discharge
B
4. A man sustained a puncture injury to his chest that caused a tension pneumothorax to form. This is a life-threatening condition because: A) Expired air exits the bleeding wound. B) Trapped, inspired air collapses the lung. C) The opposite lung hyperinflates. D) Blebs on the lung surface rupture.
B
4. The most important complication of atherosclerosis that may cause occlusion of small heart vessels is: A) Ulceration B) Thrombosis C) Fatty streaks D) Fibrous plaque
B
4. Which of the following individuals is suffering the effects of acute coronary syndrome (ACS)? A) A client whose most recent ECG indicates that silent myocardial ischemia has occurred B) A client who occasionally experiences persistent and severe chest pain when at rest C) A client who sometimes experiences chest pain when climbing stairs D) A client who has recently been diagnosed with variant (vasospastic) angina
B
4. Which of the following statements about vascular compliance is accurate? A) Arteries are much more distensible than veins. B) Veins can act as a reservoir for storing large quantities of blood. C) Arteries have thick muscular walls that constrict tightly, thereby ejecting blood without storing it for later use. D) A continuous flow through the capillaries occurs primarily during systole.
B
5. On the second or third day after an acute myocardial infarction, the area of necrosis is: A) soft and yellow. B) acutely inflamed. C) granulation tissue. D) fibrous scar tissue.
B
5. In the days following a tooth cleaning and root canal, a client has developed an infection of the thin, three-layered membrane that lines the heart and covers the valves. What is this client's most likely diagnosis? A) Pericarditis B) Endocarditis C) Myocarditis D) Vasculitis
B
6. Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary peripheral symptom, due to ischemia, is: A) edema. B) calf pain. C) varicosities. D) strong pulse.
B
6. Atherosclerotic peripheral vascular disease is symptomatic with at least 50% occlusion. The primary peripheral symptom, due to ischemia, is: A) Edema B) Calf pain C) Varicosities D) Strong pulse
B
7. In shock, one of the best indicators of blood flow to vital organs is: A) warm legs. B) urine output. C) blood pressure. D) consciousness.
B
7. Patients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant: A) heart murmurs. B) ECG changes. C) pulmonary disease. D) pericardial effusion.
B
7. A client with a history of disabling claudication now is in the emergency department with a lower limb that is turning dark purple to black associated with faint Doppler pedal pulses. The client will more than likely undergo: A) Surgery to remove the saphenous vein B) Percutaneous transluminal angioplasty and stent placement C) Injection of a potent anticoagulant into lower leg veins D) Whirlpool therapy with tight wrapping of lower legs immediately following
B
7. On the 3rd day following an acute myocardial infarction, the client is being discharged home. The nurse is explaining how the heart tissue heals following an MI. "Since today is your 3rd day after your heart attack, the tissue is: A) Soft, mushy, and yellow." B) Acutely inflamed." C) Forming granulation tissue." D) Developed a fibrous scar."
B
8. Cystic fibrosis (CF), the major cause of severe chronic respiratory disease in children, is characterized by: A) constipation. B) salt depletion. C) watery mucus. D) high cholesterol.
B
8. Dilated cardiomyopathy with left ventricular dysfunction is characterized by increased wall: A) rigidity. B) thinning. C) thickness. D) contractility.
B
16. Implantation of a pacemaker is most likely to benefit a patient with which of the following cardiomyopathies? A) Myocarditis B) Takotsubo cardiomyopathy C) Dilated cardiomyopathy (DCM) D) Primary restrictive cardiomyopathy
C
20. A client has arrived in the emergency department in cardiogenic shock. Which of the following assessment findings confirm this diagnosis? Select all that apply. A) Bright red color noted in the nail beds and lips B) Less than 5 mL dark, concentrated urine in the past hour C) BP reading of 80/65 D) Difficult to arouse with changes in level of consciousness E) Diminished breath sounds in the bases, bilaterally
B,C,D
22. A family member comes rushing out of a client's room telling the nurse that the loved one can't breathe. The nurse has just left the room after hanging IV penicillin. Which of the following clinical manifestations lead the nurse to suspect the client is experiencing anaphylactic shock? Select all that apply. A) Incontinent of urine B) Severe bronchospasm C) Wheezing sound on inspiration D) Hives over entire body E) Swelling around the lips and eyes
B,C,D,E
16. A 25-year-old cystic fibrosis client presents to the clinic in obvious respiratory distress. Following physical exam, the health care provider suspects bronchiectasis based on which of the following findings? Select all that apply. A) Crushing, substernal chest pain B) Copious amounts of foul-smelling purulent sputum C) Neck vein distention D) Blood-tinged sputum E) Wheezing throughout the lung fields
B,D,E
6. Which of the following clients would be considered at high risk for developing pneumonia (both community and hospital setting)? Select all that apply. A) A teenager who spends a lot of time at local coffee shops using Wi-Fi to chat with friends B) A young adult in motorcycle accident with head injury requiring tracheostomy and mechanical ventilation C) A college female who is pregnant (unplanned) who has been consuming alcohol prior to positive pregnancy test D) A HIV-positive client with a WBC count of 2000 who has been camping near a commercial farm raising chickens for food E) A school-aged child with severe asthma controlled by steroids admitted for an exacerbation
B,D,E
7. A family brings their elderly father to emergency department. He has been exposed to pneumococcal pneumonia at his retirement home. Today, they noted a change in his mental status. They thought he might need some oxygen. Which of the other assessment findings would correlate with this diagnosis? Select all that apply. A) Expiratory wheezes throughout all lung fields B) Increase in chest pain with deep inspiration C) Absent breathe sounds on the entire right side of the lung D) Loss of appetite for past few days E) Purulent sputum with bloody patches
B,D,E
5. A motor vehicle accident has resulted in critical injury for the driver of the car. The driver has hit the steering wheel with his chest and fractured his sternum and some ribs. Which of the following manifestations would lead the staff to suspect the driver has developed a tension pneumothorax? Select all that apply. A) Audible friction rub over the affected lung B) Mediastinal shift of the trachea toward one side C) Marked peripheral edema in lower limbs and ascites D) Atrial fibrillation noted on ECG printout E) Subcutaneous emphysema palpated in the upper chest/neck region
B,E
10. Congenital heart defects can cause a right heart to left heart shunting of blood that results in increased: A) pulmonary blood volume. B) right ventricle workload. C) unoxygenated blood flow. D) right atrial blood volume.
C
1. Because cholesterol is insoluble in plasma, it is mainly carried by the lipoprotein: A) IDL. B) HDL. C) LDL. D) VLDL.
C
11. A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his primary care provider. Which of the patients following statements indicates a need for further health-promotion teaching? A) Ive starting going to the gym before work three times a week. B) Im trying to cut back on the amount of salt that I cook with and add to my food. C) Im resolving to eat organic foods from now on and to drink a lot more water. D) Im planning to lose 15 pounds before the end of this year.
C
11. A college student is lamenting the fact that she has developed a cold on the weekend prior to exam week. Which of the following statements shows that the student has an accurate understanding of her upper respiratory infection? A) Im just going to try to rest as much as I can until these bacteria clear up. B) I think Ill go to the campus clinic and see if I can get a prescription for antibiotics. C) I suppose I should have been washing my hands more in the past few days. D) If I can just start some antihistamines as soon as possible I bet Ill get over this faster.
C
11. A patient has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. Results of this diagnostic test suggest that the patients end-diastolic volume is insufficient. Which of the following parameters of cardiac performance will directly decrease as a result of this? A) Inotropy B) Cardiac contractility C) Preload D) Afterload
C
11. Which of the following assessment findings of a cardiac patient would be suggestive of cardiac tamponade? A) Increasing PaCO2 and decreasing PaO2 B) Audible crackles on chest auscultation and presence of frothy sputum C) 20 mm Hg Drop in systolic blood pressure during respiration D) Normal ECG combined with complaints of chest pain and shortness of breath
C
11. A client asks why his blood pressure pills seem to make him go to the bathroom to urinate frequently when they are not water pills (diuretics). Which of the following physiologic processes explains the long-term regulation of blood pressure most accurately? A) Actions of the renin-angiotensin-aldosterone system B) Release of antidiuretic hormone (vasopressin) by the posterior pituitary C) Renal monitoring and adjustment of extracellular fluid volume D) Integration and modulation of the autonomic nervous system (ANS)
C
11. A male client with a history of angina has presented to the emergency department with uncharacteristic chest pain, and his subsequent ECG reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle? A) Atrial depolarization B) Ventricular depolarization C) Ventricular repolarization D) Depolarization of the AV node
C
11. Which of the following lab results strongly suggest an immunologic response in the client with possible rheumatic heart disease? A) Elevated white blood cell count B) Elevated erythrocyte sedimentation rate (ESR) C) Group A (b-hemolytic) streptococcal antibodies D) High C-reactive protein levels
C
12. 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? A) Cardiac catheterization and corticosteroid therapy B) Implanted pacemaker and b-adrenergic blockers C) Antibiotics and anti-inflammatory drugs D) Pain control and oxygen therapy
C
12. During ventricular systole, closure of the atrioventricular (AV) valves coincides with: A) Atrial chamber filling B) Aortic valve opening C) Isovolumetric contraction D) Semilunar valves opening
C
14. A patient has just been admitted to the postsurgical unit following a below-the-knee amputation. Which of the following measures should her care team prioritize to prevent atelectasis during the patients immediate recovery? A) Bedrest and supplementary oxygen by nasal cannula B) Administration of bronchodilators by nebulizer C) Deep-breathing exercises and early mobilization D) Adequate hydration and a high-humidity environment
C
14. Harmful effects on cardiac action potential are most likely to result from a deficit of which of the following electrolytes? A) Magnesium (Mg2+) B) Chloride (Cl) C) Potassium (K+) D) Hydrogen carbonate (HCO3)
C
14. The most recent blood work of a patient with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What are the most likely effects of these peptides on the patients physiology? A) Water retention B) Increased tubular sodium reabsorption C) Inhibition of the renin-angiotensin-aldosterone system D) Sympathetic nervous stimulation
C
14. A 52-year-old man who is moderately obese has recently been diagnosed with hypertension by his primary care provider. Which of the client's following statements indicates a need for further health promotion teaching? A) "I've starting going to the gym before work three times a week." B) "I'm trying to cut back on the amount of salt that I cook with and add to my food." C) "I'm resolving to eat organic foods from now on and to drink a lot more water." D) "I'm planning to lose 15 pounds before the end of this year."
C
14. A client with a diagnosis of heart failure has returned from a visit with his primary care provider with a prescription for a change in his daily medication regimen. Which of the following drugs is likely to improve the client's cardiac function by increasing the force and strength of ventricular contractions? A) A b-adrenergic blocker B) A diuretic C) A cardiac glycoside D) An ACE inhibitor
C
15. A male patient with a history of angina has presented to the emergency department with uncharacteristic chest pain and his subsequent ECG reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle? A) Atrial depolarization B) Ventricular depolarization C) Ventricular repolarization D) Depolarization of the AV node, bundle branches, and Purkinje system
C
15. Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to an enlarged heart. Which of the following disorders was the players most likely cause of death? A) Takotsubo cardiomyopathy B) Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) C) Hypertrophic cardiomyopathy (HCM) D) Dilated cardiomyopathy (DCM)
C
16. A client with persistent, primary hypertension remains apathetic about his high blood pressure, stating "I don't feel sick, and it doesn't seem to be causing me any problems that I can tell." How could the nurse best respond to this client's statement? A) "Actually, high blood pressure makes you very susceptible to getting diabetes in the future." B) "That's true, but it's an indicator that you're not taking very good care of yourself." C) "You may not sense any problems, but it really increases your risk of heart disease and stroke." D) "You're right, but it's still worthwhile to monitor it in case you do develop problems."
C
17. A childs 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? A) Cardiac catheterization and corticosteroid therapy B) Implanted pacemaker and b-adrenergic blockers C) Antibiotics and anti-inflammatories D) Pain control and oxygen therapy
C
17. A patient who developed a deep vein thrombosis during a prolonged period of bedrest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this patient at risk of experiencing? A) Cardiogenic shock B) Hypovolemic shock C) Obstructive shock D) Distributive shock
C
18. Prolonged immobility is implicated in the development of which of the following disorders? A) Bronchitis and bronchiectasis B) Sarcoidosis and idiopathic pulmonary fibrosis C) Atelectasis and pulmonary embolism D) Pulmonary hypertension and cor pulmonale
C
18. Which of the following patients should most likely be assessed for orthostatic hypotension? A) A 78-year-old woman who has begun complaining of frequent headaches unrelieved by over-the-counter analgesics. B) A patient whose vision has become much less acute in recent months and who has noticed swelling in her ankles. C) An elderly patient who has experienced two falls since admission while attempting to ambulate to the bathroom. D) A patient who has a history of poorly controlled type 1 diabetes.
C
18. A large increase in heart rate can cause: A) Increased blood viscosity B) Loss of action potential C) Decreased stroke volume D) Reduced cardiac contractility
C
18. Increased upper airway resistance and decreased airflow into the lungs in neonates (0 to 4 weeks of age) can result from: A) Frequent crying B) Sleeping supine C) Nasal congestion D) Productive coughing
C
18. Which of the following assessment findings would be suggestive of cardiac tamponade? A) Increasing PaCO2 and decreasing PaO2 B) Audible crackles on chest auscultation and presence of frothy sputum C) A 20 mm Hg drop in systolic blood pressure during respiration D) Normal ECG combined with complaints of chest pain and shortness of breath
C
19. Which of the following respiratory infections in children is associated with the poorest outcomes? A) Viral croup B) Rhinosinusitis C) Epiglottitis D) Spasmodic croup
C
19. Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which of the following disorders was the player's most likely cause of death? A) Takotsubo cardiomyopathy B) Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) C) Hypertrophic cardiomyopathy (HCM) D) Dilated cardiomyopathy (DCM)
C
2. A client has been experiencing increasing fatigue in recent months, a trend that has prompted an echocardiogram. Results of this diagnostic test suggest that the client's end-diastolic volume is insufficient. Which of the following parameters of cardiac performance will directly decrease as a result of this? A) Inotropy B) Cardiac contractility C) Preload D) Afterload
C
2. A client is diagnosed with an abdominal aortic aneurysm that the physician just wants to "watch" for now. When teaching the client about signs/symptoms to watch for, the nurse will base the teaching on which of the following physiological principles? A) Small diameter of this vessel will cause it to rupture more readily. B) The larger the aneurysm, the less tension placed on the vessel. C) As the aneurysm grows, more tension is placed on the vessel wall, which increases the risk for rupture. D) The primary cause for rupture relates to increase in abdominal pressure such as straining to have a bowel movement.
C
2. A college student is lamenting the fact that she has developed a cold on the weekend prior to exam week. Which of the following statements shows that the student has an accurate understanding of her upper respiratory infection? A) "I'm just going to try to rest as much as I can until these bacteria clear up." B) "I think I'll go to the campus clinic and see if I can get a prescription for antibiotics." C) "I suppose I should have been washing my hands more in the past few days." D) "If I can just start some antihistamines as soon as possible I bet I'll get over this faster."
C
20. A patient with a diagnosis of heart failure has returned from a visit with his primary care provider with a prescription for a change in his daily medication regimen. Which of the following drugs is likely to improve the patients cardiac function by increasing the force and strength of ventricular contractions? A) A b-adrenergic blocker B) A diuretic C) A cardiac glycoside D) An ACE inhibitor
C
20. Which of the following clients is at risk for developing a preventable disorder related to prolonged immobility? A) A middle-aged adult male diagnosed with bronchitis related to chronic smoking B) A young adult female diagnosed with sarcoidosis requiring corticosteroids to return her to remission C) A postsurgical client who is refusing to get out of bed and walk and will not wear those "uncomfortable elastic stocking" D) A sleep apnea client related to a history of smoking who utilizes a C-PAP machine every night at bedtime to maintain airway
C
21. A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this client at risk of experiencing? A) Cardiogenic shock B) Hypovolemic shock C) Obstructive shock D) Distributive shock
C
21. As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to: A) Breakdown of elastin B) Left-sided heart failure C) Pulmonary hypertension D) Expiratory airway collapse
C
21. Which of the following clients should most likely be assessed for orthostatic hypotension? A) A 78-year-old woman who has begun complaining of frequent headaches unrelieved by over-the-counter analgesics B) A 65-year-old client whose vision has become much less acute in recent months and who has noticed swelling in her ankles C) An 80-year-old elderly client who has experienced two falls since admission while attempting to ambulate to the bathroom D) A 42-year-old client who has a history of poorly controlled type 1 diabetes
C
22. A mother rushes her toddler into the emergency department stating, "My baby can't breathe." Initial assessment reveals the child is struggling to breathe in an upright position. He has both inspiratory and expiratory stridor and is using his chest muscles to breath. The nurse suspects the child has which of the following acute respiratory infections? A) Croup B) Asthma C) Epiglottitis D) Bronchiolitis
C
22. Congenital heart defects can cause a right heart-to-left heart shunting of blood that results in increased: A) Pulmonary blood volume B) Right ventricle workload C) Unoxygenated blood flow D) Right atrial blood volume
C
22. Following a kitchen accident with a knife, the client's cut has experienced a decrease in the amount of bleeding and has developed a clot. The nurse knows this is primarily a result of humoral control of blood flow with the release of: A) Histamine B) Bradykinin C) Serotonin D) Prostaglandin E2
C
23. A child is brought to the emergency department with a respiratory infection. The child is struggling to breath and is very anxious. The health care providers suspect epiglottitis. Which of the following interventions would be a priority? A) Have parents help hold the child down so blood work can be drawn and sent to lab so WBC count can be reviewed. B) Try to get the child to open his mouth so you can put a tongue blade in the back of the throat to look for swelling or pustules. C) Place the child upright in bed and begin preparing for a tracheostomy placement. D) Administer the first dose of an antibiotic vial liquid suspension as soon as possible to begin fighting the infection.
C
23. A client has had a myocardial infarction (MI) that damaged the right atrium, which has interfered with the SA node. The compensatory mechanism, the AV node, becomes the pacemaker of the heart and beats how many times/minute? A) 10 to 20 beats/minute B) 21 to 30 beats/minute C) 45 to 50 beats/minute D) 55 to 60 beats/minute
C
25. The parasympathetic nervous system causes a slowing of the heart rate by increasing: A) Norepinephrine B) Vessel constriction C) Cardioinhibitory center D) Smooth muscle tone
C
4. In adults, sudden death from an acute myocardial infarction is usually caused by: A) acute myocarditis. B) high troponin levels. C) acute ventricular arrhythmia. D) hypertrophic cardiomyopathy.
C
5. A father experienced the onset of chest pain and dies suddenly. The family asks, "What caused him to die so suddenly?" The health care provider's reply that is most appropriate would be, "There's a high probability that your loved one developed an acute heart attack and experienced: A) Acute myocarditis." B) High troponin levels." C) Acute ventricular arrhythmia." D) Hypertrophic cardiomyopathy."
C
5. The most recent blood work of a client with a diagnosis of heart failure indicates increased levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). What is the most likely effect of these peptides on the client's physiology? A) Water retention B) Increased tubular sodium reabsorption C) Inhibition of the renin-angiotensin-aldosterone system D) Sympathetic nervous stimulation
C
6. As a result of hypoxemia and polycythemia, persons with chronic obstructive bronchitis are prone to: A) breakdown of elastin. B) left-sided heart failure. C) pulmonary hypertension. D) expiratory airway collapse.
C
6. In aortic regurgitation, failure of aortic valve closure during diastole causes an abnormal drop in diastolic pressure. This change in pressure causes decreased: A) stroke volume. B) left ventricular size. C) coronary perfusion. D) arterial pulse pressure.
C
7. A large increase in heart rate can cause: A) increased blood viscosity. B) loss of action potential. C) decreased stroke volume. D) reduced cardiac contractility.
C
7. Increased upper airway resistance and decreased airflow into the lungs in neonates (0 to 4 weeks of age) can result from: A) frequent crying. B) sleeping supine. C) nasal congestion. D) productive coughing.
C
7. Heart muscle differs from skeletal muscle tissue by being able to generate: A) Contractions B) Calcium influx C) Action potentials D) Sarcomere binding
C
8. Because of its location, the presence of an abdominal aortic aneurysm may first be noticed as: A) constipation. B) indigestion. C) a pulsating mass. D) mid-abdominal pain.
C
8. A client has just been admitted to the postsurgical unit following a below-the-knee amputation. Which of the following measures should her care team prioritize to prevent atelectasis during the client's immediate recovery? A) Bedrest and supplementary oxygen by nasal cannula B) Administration of bronchodilators by nebulizer C) Deep-breathing exercises and early mobilization D) Adequate hydration and a high-humidity environment
C
9. By definition, hypertension is systolic blood pressure of ____ mm Hg or higher or diastolic blood pressure of ____ mm Hg or higher. A) 129; 85 B) 138; 89 C) 140; 90 D) 155; 95
C
9. The adverse effects of emboli on the pulmonary circulation and airways include: A) excess surfactant. B) area bronchodilation. C) local vasoconstriction. D) lower lobe consolidation.
C
9. The tissue factor that contributes to humoral control of blood flow by causing vasoconstriction is: A) histamine. B) bradykinin. C) serotonin. D) nitric oxide.
C
9. Which of the following acute respiratory infections in children poses the greatest threat of severe hypoxia caused by inflammatory edema? A) Croup B) Asthma C) Epiglottitis D) Bronchiolitis
C
9. Because of its location, the presence of an abdominal aortic aneurysm may first be manifested as: A) Constipation B) Indigestion C) A pulsating mass D) Midabdominal pain
C
A patient with persistent, primary hypertension remains apathetic about his high blood pressure, stating, I dont feel sick, and it doesnt seem to be causing me any problems that I can tell. How could a clinician best respond to this patients statement? A) Actually, high blood pressure makes you very susceptible to getting diabetes in the future. B) Thats true, but its an indicator that youre not taking very good care of yourself. C) You may not sense any problems, but it really increases your risk of heart disease and stroke. D) Youre right, but its still worthwhile to monitor it in case you do develop problems.
C
During ventricular systole, closure of the atrioventricular (AV) valves coincides with: A) atrial chamber filling. B) aortic valve opening. C) isovolumetric contraction. D) semilunar valves opening.
C
Heart muscle differs from skeletal muscle tissue by being able to generate: A) contractions. B) calcium influx. C) action potentials. D) sarcomere binding.
C
Which of the following physiologic processes contributes most to the long-term regulation of blood pressure? A) Actions of the renin-angiotensin-aldosterone system B) Release of antidiuretic hormone (vasopressin) by the posterior pituitary C) Renal monitoring and adjustment of extracellular fluid volume D) Integration and modulation of autonomic nervous system (ANS)
C
8. When discussing the AV node's role in the electrical conduction of the heart with a client newly diagnosed with an AV block, which of the following statements are accurate? Select all that apply. A) The AV node offers a two-way conduction area between the atria and the ventricles. B) The velocity of conduction through the AV junctional fibers is very fast, which greatly increases impulse transmission. C) A block at the AV bundle of His interferes with the normal delay of the impulse, thereby interfering with complete ejection of blood from the atria prior to ventricular contraction. D) When there is an AV block, impulses from the atria and ventricles beat independently of each other so, the heart rhythm is usually chaotic and not regular.
C,D
15. Which of the following manifestations typically accompanies an asthmatic attack? A) Decreased residual volume B) Decreased pulmonary arterial pressure C) Prolonged inspiration D) Hyperinflation of the lungs
D
1. A client with a history of emphysema is experiencing hypoxemia after a taxing physical therapy appointment. Which of the following physiologic phenomena will occur as a consequence of hypoxemia? A) Peripheral vasodilation B) Necrosis C) Hypoventilation D) Increased heart rate
D
10. The patient is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the mid-calf area. He has many of the manifestations of: A) stasis ulcerations. B) arterial insufficiency. C) primary varicose veins. D) deep vein thrombosis.
D
10. The pathogenic capacity of the tubercle bacillus is related to: A) Formation of a Ghon focus lesion B) Its inherent destructive capabilities C) Rapid viral replication in host cells D) The initiation of a cell-mediated immune response
D
10. Which of the following manifestations typically accompanies an asthmatic attack? A) Decreased residual volume B) Decreased pulmonary arterial pressure C) Prolonged inspiration D) Hyperinflation of the lungs
D
11. A patient with a history of emphysema is experiencing hypoxemia after a taxing physical therapy appointment. Which of the following physiologic phenomena will occur as a consequence of hypoxemia? A) Peripheral vasodilation B) Necrosis C) Hypoventilation D) Increased heart rate
D
12. A patient has presented to an ambulatory clinic complaining of a persistent headache. What assessments should the clinician conduct to differentiate between rhinosinusitis and alternative health problems? A) Take a sputum sample for culture and sensitivity. B) Compare the patients oral, tympanic, and axillary temperatures and order a white blood cell count. C) Palpate the patients lymph nodes and inspect the ears with an otoscope. D) Perform transillumination and ask the patient if bending forward exacerbates the headache.
D
12. Which of the following health problems is associated with heart failure as a result of diastolic dysfunction? A) Uncontrolled hypertension B) Chronic bradycardia C) Ischemic heart disease D) Myocardial hypertrophy
D
12. While in the ICU, a client's status changes. The health care providers suspect heart failure. Which of the following diagnostic procedures would give the staff information about pulmonary capillary pressures, which will lead to the most appropriate interventions? A) Echocardiography B) Radionuclide ventriculography C) Cardiac magnetic resonance imaging D) Hemodynamic monitoring
D
13. Following several weeks of increasing fatigue and a subsequent diagnostic work-up, a patient has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the following consequences? A) Backup of blood from the right atrium into the superior vena cava B) Backflow from the right ventricle to the right atrium during systole C) Inhibition of the SA nodes normal action potential D) Backflow from the left ventricle to left atrium
D
13. A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis? A) "I'll be sure to take my beta blocker whenever I feel short of breath." B) "I'm going to avoid as much physical activity as I can so that I preserve my strength." C) "I know it's healthy to drink a lot of water, and I'm going to make sure I do this from now on." D) "I'm trying to think of ways that I can cut down the amount of salt that I usually eat."
D
15. A nurse is performing patient health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis? A) Ill be sure to take my beta blocker whenever I feel short of breath. B) Im going to avoid as much physical activity as I can so that I preserve my strength. C) I know its healthy to drink a lot of water, and Im going to make sure I do this from now on. D) Im trying to think of ways that I can cut down the amount of salt that I usually eat.
D
15. A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will not respond to medications. The physicians suggest placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. The health care providers respond: A) "Pull your blood from the right side of the heart and run it through a machine to oxygenate it better, and then return it to your body." B) "Measure the pressures inside your heart continuously to asses pumping ability of your left ventricle." C) "Have a probe at the end of a catheter to obtain thermodilution measures, so cardiac output can be calculated." D) "This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."
D
17. Which of the following individuals is most clearly in need of diagnostic testing for lung cancer? A) A patient who has required hospitalization with a fever and the production of copious lung secretions B) A patient with a history of secondary tuberculosis who failed to complete his prescribed course of antibiotics C) A woman who complains of recurrent lower respiratory infections and who has sought care for increasing shortness of breath D) A man who demonstrates wasting of the pelvic and shoulder muscles combined with signs of hypercalcemia
D
17. A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of: A) Pulmonary embolism due to development of deep vein thrombosis B) Side effects from versed administration causing excessive vasoconstriction C) Renal failure due to an overdose of medication D) Hypovolemic shock due to acute intravascular volume loss
D
17. A client was in car accident client while not wearing a seatbelt and has sustained multiple rib fractures. During assessment, the nurse is having a hard time hearing heart sounds, and the client reports chest pain/pressure repeatedly. This client may be experiencing: A) Cardiomyopathy B) Pericarditis C) Pulmonary hypertension D) Pericardial effusion
D
17. Hypoxia is said to have a negative inotropic effect on the heart, which means: A) The heart rate will slow down, so the atria and ventricles can fill better. B) The cardiac output will decrease to cause less work for the heart. C) The heart will adjust so that less time will be spent in diastole and filling of the ventricles will shorten. D) There will be interference in the generation of ATP, which is needed for muscle contraction.
D
17. Which of the following individuals is most clearly in need of diagnostic testing for lung cancer? A) A client who has required hospitalization with a fever and the production of copious lung secretions B) A client with a history of secondary tuberculosis who failed to complete his prescribed course of antibiotics C) A woman who complains of recurrent lower respiratory infections and who has sought care for increasing shortness of breath D) A man who demonstrates wasting of the pelvic and shoulder muscles combined with signs of hypercalcemia
D
19. Persistent cyanosis has led an infants care team to suspect a congenital heart defect. Which of the following assessment findings would suggest coarctation of the infants aorta? A) The child has a split S2 heart sound on auscultation. B) ECG reveals atrial fibrillation. C) The child experiences apneic spells after feeding. D) Blood pressure in the childs legs is lower than in the arms.
D
19. Release of which of the following humoral factors will result in vasodilation? A) Norepinephrine B) Angiotensin II C) Serotonin D) Histamine
D
20. A postsurgical patients complaints of calf pain combined with the emergence of swelling and redness in the area have culminated in a diagnosis of deep vein thrombosis. What treatment options will be of greatest benefit to this patient? A) Analgesics and use of a pneumatic compression device B) Massage followed by vascular surgery C) Frequent ambulation and the use of compression stockings D) Anticoagulation therapy and elevation of the leg
D
20. Pain is an expected assessment finding in patients who have which of the following lung diseases? A) Asthma B) Pleural effusion C) Pulmonary arterial hypertension (PAH) D) Pleuritis
D
20. Which of the following assessment findings of a cyanotic infant is incongruent with a diagnosis of tetralogy of Fallot? A) The child has ventricular septal defect. B) The infants pulmonary outflow channel is narrowed. C) The child has right ventricular hypertrophy. D) The infants aorta is narrowed.
D
23. With acute respiratory distress syndrome (ARDS), a client progressively increases his work of breathing. The physiological principle behind this respiratory distress is related to: A) Increases in left atrial pressure causing thickening of the lining of the pulmonary arteries B) The elevation of pulmonary venous pressure C) Structural abnormalities of pulmonary vessels with proliferation of the vessel intima D) The stiffening of the lung, making it more difficult to inflate
D
24. Persistent cyanosis has led an infant's care team to suspect a congenital heart defect. Which of the following assessment findings would suggest coarctation of the infant's aorta? A) The child has a split S2 heart sound on auscultation. B) ECG reveals atrial fibrillation. C) The child experiences apneic spells after feeding. D) Blood pressure in the child's legs is lower than in the arms.
D
24. Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by: A) Hyperventilation B) Excessive surfactant C) Hyperinflated alveolar sacs D) Ventilation-perfusion mismatch
D
24. The client is immobilized following a hip injury and has begun demonstrating lower leg discoloration with edema, pain, tenderness, and increased warmth in the midcalf area. He has many of the manifestations of: A) Stasis ulcerations B) Arterial insufficiency C) Primary varicose veins D) Deep vein thrombosis
D
25. 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? A) Increase oxygen level to 10 L/min. B) Begin Bi-PAP. C) Call respiratory therapy to suction the client. D) Prepare for mechanical ventilation.
D
25. A postsurgical client reports calf pain combined with the emergence of swelling and redness in the area, which have culminated in a diagnosis of deep vein thrombosis. What treatment options will be of greatest benefit to this client? A) Analgesics and use of a pneumatic compression device B) Massage followed by vascular surgery C) Frequent ambulation and the use of compression stockings D) Anticoagulation therapy and elevation of the leg
D
3. Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart. A) ruptures; releases B) thickens; stretches C) contracts; friction rubs D) fills rapidly; compresses
D
3. A client has presented to an ambulatory clinic complaining of a persistent headache. What assessments should the clinician conduct to differentiate between rhinosinusitis and alternative health problems? A) Take a sputum sample for culture and sensitivity. B) Compare the client's oral, tympanic, and axillary temperatures and order a white blood cell count. C) Palpate the client's lymph nodes and inspect the ears with an otoscope. D) Perform transillumination and ask the client if bending forward exacerbates the headache.
D
3. Which elevated serum marker for systemic inflammation is now considered a major risk factor for atherosclerosis and vascular disease? A) Leukocytosis B) Homocysteine C) Serum lipoprotein D) C-reactive protein
D
4. A serum marker for systemic inflammation, _______, is now considered a major risk factor marker for atherosclerosis, and vascular disease. A) leukocytosis B) homocysteine C) serum lipoprotein D) C-reactive protein
D
4. The pathogenic capacity of the tubercle bacillus is related to: A) formation of a Ghons focus lesion. B) its inherent destructive capabilities. C) rapid viral replication in host cells. D) the initiation of a cell-mediated immune response.
D
5. Small-vessel vasculitides, a group of vascular disorders that cause vasculitis, are mainly mediated by: A) infectious agents. B) tissue necrosis. C) mononuclear cells. D) hypersensitivity reactions.
D
5. In addition to direct invasion of the vascular wall by an infectious agent, this pathogenic mechanism is a common cause of vasculitis? A) Necrotizing granulomatous B) Tissue necrosis C) Mononuclear cells D) Immune-mediated inflammation
D
6. Hypovolemic shock occurs as a result of: A) myocardial infarction. B) excessive vasoconstriction. C) chronic intracellular fluid shift. D) acute intravascular volume loss.
D
6. A car accident client is admitted with a chest tube following pneumothorax. He also has an elevated blood alcohol level. When the nurse enters his room, she notes the client is dyspneic, short of breath, and holding his chest tube in his hand. When the nurse pulls the linens back, she finds a "sucking" chest wound. After calling a "code blue," the next priority intervention would be to: A) Place the client's meal napkin over the wound B) Observe and wait for the code blue team to bring equipment C) Try to calm the patient down by maintaining therapeutic communication D) Apply a Vaseline gauze (airtight) dressing over the insertion site
D
6. Following several weeks of increasing fatigue and a subsequent diagnostic workup, a client has been diagnosed with mitral valve regurgitation. Failure of this heart valve would have which of the following consequences? A) Backup of blood from the right atrium into the superior vena cava B) Backflow from the right ventricle to the right atrium during systole C) Inhibition of the SA node's normal action potential D) Backflow from the left ventricle to the left atrium
D
7. Although both are characterized by ischemia, Raynaud phenomenon is caused by _________, and thromboangiitis obliterans is caused by: A) occlusion; compression. B) thrombi; vasoconstriction. C) vasculitides; hypertension. D) vasospasm; inflammation.
D
8. Anaphylactic shock is directly associated with: A) loss of blood volume. B) bacterial blood infection. C) failure of the heart as a pump. D) type I hypersensitivity response.
D
8. A health care provider was asked by a client, "Why do my hands turn blue when I drive my car in the winter without gloves?" Which of the following is the best response? A) "Nothing to worry about. We all develop this as we age." B) "We better order a CT scan. It might be due to a blood clot in your radial artery." C) "This sounds like an inflammation in the lining of your veins. You need to take some NSAIDs." D) "Your arteries in your hands/fingers are going into spasm, which decreases blood flow and circulating oxygen."
D
9. Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by: A) chronic atrial fibrillation. B) myocardial inflammation. C) left ventricle hypertrophy. D) vegetative valve destruction.
D
9. Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by: A) hyperventilation. B) excessive surfactant. C) hyperinflated alveolar sacs. D) ventilation-perfusion mismatch.
D
9. Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by: A) Chronic atrial fibrillation B) Myocardial inflammation C) Left ventricle hypertrophy D) Vegetative valve destruction
D
9. If the parasympathetic neurotransmitter releases acetylcholine, the nurse should anticipate observing what changes in the ECG pattern? A) Heart rate 150 beats/minute, labeled as supraventricular tachycardia B) Disorganized ventricular fibrillation C) Complete cardiac standstill D) Slowing of heart rate to below 60 beats/minute
D