ch 17 prep u 2nd version
A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be: a) The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. b) The valve opening is incompetent, thereby allowing blood to flow back from the pulmonary artery and into the left atrium. c) The valve opening permits backward flow to occur when the valve should be closed. d) The valve opens backward permitting blood to flow from the right ventricle into the right atrium.
A
A client has just experienced stimulation of the vagus nerve. Which of the following would the nurse anticipate to manifest in this client? a) Decreased heart rate b) Decreased blood coagulation c) Increased heart rate d) Increased cardiac contractility
A
A patient is diagnosed with right-sided heart failure. The nurse knows that a frequent sign of this type of failure is peripheral edema, evidenced by which of the following? a) Weight gain b) Shortness of breath c) Copious urination d) Decreased blood pressure
A
Heart failure may be systolic or diastolic dysfunction. Which of the following statements regarding systolic and diastolic dysfunction are correct? Select all that apply. a) Separation into systolic or diastolic dysfunction is based on ventricular ejection fraction. b) In systolic dysfunction, the ejection fraction is decreased. c) In systolic dysfunction, preload increases. d) In diastolic dysfunction, the ejection fraction decreases. e) In diastolic dysfunction, preload increases.
ABC
The heart consists of four valves. Which are the semilunar values? Select all that apply. a) Aortic b) Mitral c) Tricuspid d) Pulmonary
AD
The nurse knows that acute regulation of blood pressure involves which of the following physiological processes? Select all that apply. a) Arterial chemoreceptors b) Adrenergic (sympathetic) stimulation c) Vagal nerve impulses d) Carotid baroreceptors e) Renal regulation of blood volume
AbCd
A clinically obese patient diagnosed with stage 2 hypertension is resistant to taking antihypertensive medication because he has no symptoms and "feels fine." The nurse will encourage this patient to attempt lowering his blood pressure in order to decrease the risk of developing which of the following? Select all that apply. a) Coronary artery disease b) Diabetes c) Dementia d) Renal failure e) Loss of vision
Acde
A patient is diagnosed with orthostatic hypotension. The nurse knows that drugs which can predispose a patient to orthostasis include which of the following? Select all that apply. a) Psychotropics b) Bronchodilators c) Antibiotics d) Antihypertensives e) Diuretics
Ade
(STEMI) experienced "sudden death." The emergency room nurse explains sudden death from a STEMI as death that occurs within what time frame of symptom onset? a) 30 minutes b) 1 hour c) 2 hours d) 15 minutes
B
Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins? a) Diuretic b) Vasoconstriction c) Vasodilation d) Natriuretic
B
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) Pericarditis b) Cor pulmonale c) Right-sided heart failure d) Cardiogenic shock
C (A major effect of right-sided heart failure is the development of peripheral edema. A client who is in shock would not have stable vital signs. Cor pulmonale would be accompanied by manifestations of lung disease.)
The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope? a) Over the aorta b) Over the sternum c) At the apex of the heart d) At the carotid arteries
C (relates to HAP)
The physician states that a client has adequate collateral circulation. The nurse interprets this as: a) Development of increased collagen b) Establishment of compensatory lymphatic drainage c) Anastomosis of the arterial and venous circulation d) Long-term compensatory regulation of blood flow
D
A nurse is teaching a patient with newly diagnosed hypertension about antihypertensive drug therapy. The nurse determines that the patient understands when the patient correctly describes which of the following as the mechanism of action of an angiotensin-converting enzyme (ACE) inhibitor? a) Decreases the heart rate, which will cause a decrease in cardiac output b) Inhibit the movement of calcium into cardiac and vascular smooth muscle c) Decreases vascular volume by suppressing renal reabsorption of sodium d) Inhibition of the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction
D
Sepsis is growing in incidence in the United States. Its pathogenesis includes neutrophil activation, which kills microorganisms. Neutrophils also injure the endothelium, releasing mediators that increase vascular permeability. What else do neutrophils do in sepsis? a) Cause bradycardia b) Vasoconstrict the capillary bed c) Activate erythropoiesis d) Release nitric oxide
D
The heart valves control the direction of blood flow. What is the function of the pulmonic valve? a) Controls the direction of blood flow from the right side of the heart to the systemic circulation b) Controls the direction of blood flow from the left side of the heart to the lungs c) Controls the direction of blood flow from the left side of the heart to the systemic circulation d) Controls the direction of blood flow from the right side of the heart to the lungs
D
The physician's order states, "Calculate the pulse pressure of the client's B/P." The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be: a) 41mm Hg b) 228 mm Hg c) 73 mm Hg d) 64 mm Hg
D
A patient has a narrowed pulse pressure. The nurse knows that the major factors that influence pulse pressure include which of the following? Select all that apply a) Heart rate b) Blood viscosity c) Duration of diastole d) Distensability of the arteries e) Stroke volume
DE
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) Wall thickness of small vessels has decreased due to hypotension. c) Decreasing vessel radii have caused a decrease in blood pressure. d) Decreases in wall tension and blood pressure have caused a sudden increase in vessel radii.
a
A client has prominent jugular veins. What type of medical problem is associated with prominent jugular veins? a) Right sided heart failure b) Left sided heart failure c) Cerebral vascular accident d) Shock
a
A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing: a) Onset of STEMI b) Gastroesophageal reflux disease (GERD) c) Acute respiratory distress syndrome (ARDS) d) Pneumonia
a
Proper perfusion of vital organs requires which of the following conditions? Select all that apply. a) Ability of organs to extract oxygen and nutrients from blood b) Efficient renal function c) Intact vascular system d) Sufficient blood volume to fill the vascular compartment e) Efficient cardiac pumping ability
aCDe
A nurse is evaluating hypertension risk factors with an African American male who is a lawyer in a busy legal firm. He reports that he eats fairly well, usually having red meat and potatoes daily. His father and older brother have hypertension. His paternal grandfather had a stroke. The lawyer drinks about four beers and eats salted popcorn while watching television in the evening and has gained 15 pounds in the past year. Which of the following are nonmodifiable risk factors associated with this diagnosis? Select all that apply. a) Race b) Family history c) Obesity d) Stress e) Excessive alcohol consumption
ab (not C)
In heart failure patients, the nurse knows that many compensatory mechanisms attempt to support cardiac output. Included among these mechanisms are which of the following? Select all that apply. a) Activitation of the renin angiotensin system (RAAS) b) Increased heart rate c) Vasoconstriction d) Decreased endothelin release e) Decreased sodium and water retention
abc
The nurse is assessing a 77-year-old client who has been diagnosed with hypertension. Which age-related physiologic changes may have contributed to the client's diagnosis? Select all that apply. a) Decreased renal blood flow b) Increased friction at epithelial surfaces of large vessels c) Decreased blood viscosity d) Decreased sensitivity of baroreceptors e) Decreased compliance of the aorta
ade
A client has been prescribed a thiazide diuretic, hydrochlorothiazide (HCTZ), for the initial treatment of hypertension. What effect does the nurse know this drug will have to decrease blood pressure? a) Decrease heart rate b) Decrease vascular volume c) Increase vasoconstriction d) Decrease renin release
b
The nurse is caring for a client who has just experienced an acute myocardial infarction and is diagnosed with "pump failure." The nurse is aware that the client is experiencing which type of shock? a) Septic b) Cardiogenic c) Hypovolemic d) Neurogenic
b
A 20-year-old male client is experiencing a severe immunologically mediated reaction in which histamines have been released into the blood. Select the type of reaction most likely occurring with this client. a) Neurogenic shock b) Distributive shock c) Septic shock d) Anaphylatic shock
d
Anaphylactic shock is directly associated with: a) failure of the heart as a pump. b) loss of blood volume. c) bacterial blood infection. d) type I hypersensitivity response.
d
The nurse knows that which of the following persons is at greatest risk for malignant hypertension? a) A 60-year-old woman with newly diagnosed mild hypertension b) An obese 46-year old Caucasian man c) A 30-year-old woman with three children d) A 25-year-old African-American man
d
Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another? a) Axially b) Crosswise c) Turbulent d) Laminar
d
Which of the following is the best modality to diagnose hypertension? a) Laboratory blood analysis b) Tissue analysis c) X-ray d) Repeated blood pressure determinations
d
A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess. a) Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy b) Blood pressure 140/90 and glucose in the urine during the 36th week of pregnancy c) Blood pressure 90/60 and proteinuria in the second trimester d) Blood pressure 130/88 and hyperglycemia occurring during the 22nd week of pregnancy
A
An elderly patient is diagnosed with orthostatic hypotension. For which of the following clinical manifestations should the nurse assess? a) Dizziness and fainting b) Nausea and vomiting c) Headache and double vision d) Chest pain and palpitations
A
In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which of the following levels indicates inadequate renal perfusion? a) 20 mL/hour b) 80—60 mL/hour c) 40—20 mL/hour d) 60—40 mL/hour
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 cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level. What is the normal young adult's percentage cardiac reserve? a) 300% - 400% b) 100% - 200% c) 200% - 300% d) 400% - 500%
A
The nurse is preparing to auscultate a client's blood pressure. Which information obtained from the client would indicate that the nurse should wait 30 minutes prior to obtaining a reading? a) The client just smoked a cigarette. b) The client took her antihypertensive medication 2 hours ago. c) The client left work 1 hour ago. d) The client ate a hamburger 45 minutes prior to the reading.
A
The nurse knows that coarctation of the aorta can be a secondary cause of hypertension. Which of the following blood pressure findings can be characteristic of this condition? a) Blood pressure in arms 20 mm Hg higher than in the legs b) Prominent femoral pulses c) Widened pulse pressure in the legs d) Blood pressure in legs 20 mm Hg higher than in the arms
A
The nurse knows that which group of antihypertensive drugs is usually the least expensive and is well tolerated? a) Diuretics b) Calcium channel blockers c) Beta adrenergic blockers d) Angiotensin converting enzyme inhibitors
A (I knew this)
The nurse observes a client care technician obtain a blood pressure on an obese client using a BP cuff that is too small. The nurse is aware that this will result in: a) A reading that is too high b) A reading that is too low c) A decreased pulse pressure reading d) An accurate BP assessment
A (Just like HAP)
The nurse identifies the blood vessel layer that constricts to regulate and control diameter as which of the following? a) Tunica intima b) Tunica adventitia c) Tunica media d) Tunica externa
c
A client has experienced sympathetic nervous stimulation of the heart. The nurse is aware that the client may manifest which of the following? a) Decreased rate and force of contraction b) Increased heart rate and increased contractility c) Decreased contractility and decreased heart rate d) Increased heart rate and decreased contractility
B
A client is prescribed an angiotensin-converting enzyme (ACE) inhibitor for treatment of hypertension. What expected outcome does the nurse expect this medication will have? a) Will increase extracellular fluid and decrease venous pressure b) Will prevent the conversion of angiotensin I to angiotensin II c) Will increase oxygen consumption of the heart d) Will have a direct vasoconstrictive effect on vessels of splanchnic circulation
B
A nurse is assessing a client in shock for complications of acute renal failure. The most important assessment for the nurse to obtain would be: a) Evaluating the blood for a decreased creatinine level b) Continuous measurement of urine output c) Asking the client if he is having bilateral flank pain d) Evaluating the blood for a decrease in the blood urea nitrogen level (BUN)
B
A patient's blood pressure is persistently in the range of 130-135 mm Hg systolic and 85-88 mm Hg diastolic. The nurse knows that which of the following conditions correctly describes this patient's blood pressure? a) Stage 1 Hypertension b) Prehypertension c) Normal blood pressure d) Stage 2 Hypertension
B
Four clients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which client most likely experienced myocardial infarction? a) 61-year-old man whose pain started at 9 AM during a short walk and responded to nitrates, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened b) 80-year-old woman whose pain was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose c) 67-year-old woman whose pain started at 2 AM while she was asleep and that responded to nitrates; the ECG showed arrhythmias and ST-segment elevation; cardiac markers remained stable d) 33-year-old man whose pain started at 7 AM during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable
B
Humoral control of blood flow involves the effect of vasodilator and vasoconstrictor substances in the blood. Stimulation of the sympathetic nervous system during stress or exercise causes local constriction because of the release of which hormone? a) Histamine b) Norepinephrine c) Angiotensin II d) Epinephrine
B
Persons with hypertension secondary to hyperaldosteronism may be treated with which of the following drugs? a) Alpha adrenergic antagonists b) Potassium-sparing diuretics c) Angiotensin converting enzyme inhibitors (ACEI) d) Beta adrenergic blockers
B
The nurse knows that hypertension can lead to nephrosclerotic damage. Which of the following occurs first in nephrosclerosis? a) Glomerular sclerosis b) Tubulointerstitial fibrosis c) Diabetic nephropathy d) Glomerular hypoperfusion
B
The nurse knows that systolic hypertension is characterized by systolic pressure of ____mm Hg or higher. a) 151 b) 140 c) 160 d) 90
B
The nurse knows that there are many different groups of antihypertensive drugs having varied mechanisms of action. Which one of the following drugs decreases the exit of adrenergic (sympathetic) stimulation from the central nervous system? a) An alpha-1 adrenergic antagonist b) An alpha-2 adrenergic agonist c) An alpha-2 adrenergic antagonist d) An angiotensin converting enzyme inhibitor (ACEI)
B
Which of the following is the correct sequence for blood flow through the heart? a) Left atrium - tricuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein -right atrium - mitral valve - right ventricle - aorta b) Right atrium - tricuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein - left atrium - mitral valve - left ventricle - aorta c) Right atrium - bicuspid valve - right ventricle - pulmonary artery - lungs - pulmonary vein -left atrium - tricuspid valve - left ventricle - aorta d) Left atrium - bicuspid valve - left ventricle - pulmonary artery - lungs - pulmonary vein -right atrium - tricuspid valve - right ventricle - aorta
B
The health care provider is preparing to assess a client who has been diagnosed with hypertrophic cardiomyopathy. The provider anticipates the assessment data will include: a) Systolic dysfunction b) Enlarged chamber size c) Orthopnea d) Reduced chamber size
B (Hypertrophic cardiomyopathy (HCM) is characterized by unexplained left ventricular hypertrophy with disproportionate thickening of the ventricular septum, abnormal diastolic filling, cardiac arrhythmias and, in some cases, intermittent left ventricular outflow obstruction. The other choices are findings in dilated cardiomyopathy.)
The heart consists of four valves. Which are the heart's atrioventricular valves? Select all that apply. a) Aortic b) Mitral c) Tricuspid d) Pulmonary
BC
The nurse is providing education for a patient diagnosed with essential hypertension. The nurse will state that the cause of this disorder is which of the following? a) Pheochromocytoma b) Decreased renal blood flow c) Hyperaldosteronism d) Unknown
D
The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is: a) 80 mL/hour b) 40 mL/hour c) 20 mL/hour d) 60 mL/hour
c
Anaphylactic shock is the most severe form of systemic allergic reaction. Immunologically medicated substances are released into the blood, causing vasodilation and an increase in capillary permeability. What physiologic response often accompanies the vascular response in anaphylaxis? a) Laryngeal edema b) Gastrointestinal relaxation c) Uterine smooth muscle relaxation d) Bronchodilation
a
Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells? a) Hypertrophy b) Hyperplasia c) Dysplasia d) Atrophy
a
The nurse knows that the primary long-term regulation of blood pressure is exerted by which of the following? a) The kidneys b) Neural mechanisms c) Humoral influence d) Hormonal activity
a
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below which of the following? a) 100/60 b) 100/90 c) 140/90 d) 140/60
c
For which of the following types of shock might intravenous antibiotic therapy be indicated? a) Distributive shock b) Obstructive shock c) Hypovolemic shock d) Cardiogenic shock
a (Septic shock is a subtype of distributive shock. The treatment of sepsis and septic shock focuses on control of the causative agent and support of the circulation and the failing organ systems. The administration of antibiotics that are specific for the infectious agent is essential. Swift and aggressive fluid administration is needed to compensate for third spacing, though which type of fluid is optimal remains controversial. Equally, aggressive use of vasopressor agents, such as norepinephrine or epinephrine, is needed to counteract the vasodilation caused by inflammatory mediators.)
On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right heart failure. Which of the following manifestations exhibited by the father does the nurse know might have preceded this diagnosis? a) Dyspnea, cough b) Peripheral edema weight gain c) Vertigo, headache d) Weakness, palpitations
b
A 20-year-old college student has a pelvic fracture and a severed leg from a motorcycle accident. She lost several units of blood. When the student arrived in the emergency department, her blood pressure was very low, her pulse was high, and her skin was pale. The nurse knows that this patient has developed which of the following types of shock? a) Cardiogenic b) Hypovolemic c) Distributive d) Obstructive
b
A 60-year-old woman who has lost an extensive amount of blood in a work-related accident says that when her blood pressure was checked in the hospital, the top number (systolic pressure) was lower than usual but the bottom number (diastolic pressure) was about the same. The nurse recognizes that which of the following accounts for this lack of change in the diastolic pressure? a) Heart rate increased with blood loss. b) Systemic vasoconstriction maintained the diastolic pressure. c) Blood volume rapidly increased. d) Stroke volume increased with blood loss.
b
A client who has suffered a myocardial infarction is being treated in the emergency room. His pain remains severe even though he was given nitrates and oxygen. The physician now orders morphine for the pain. What method should the nurse to administer the morphine? a) By mouth in a liquid b) Intravenous c) Subcutaneous d) By mouth in pill form
b
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 patient's end-diastolic volume is insufficient. Which of the following parameters of cardiac performance will directly decrease as a result of this? a) Afterload b) Preload c) Inotropy d) Cardiac contractility
b
A patient is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as which of the following? a) Pericardial effusion b) Valvular regurgitation c) Infective endocarditis d) Valvular stenosis
b
Downstream peripheral pulses have a higher pulse pressure because the pressure wave travels faster than the blood itself. What occurs in peripheral arterial disease? a) Downstream peripheral pulses are increased even more than normal. b) The pulse decreases rather than increases in amplitude. c) Downstream peripheral pulses are greater than upstream pulses. d) The reflected wave is transmitted more rapidly through the aorta.
b
The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be: a) Physical inactivity and high serum high-density lipoprotein cholesterol b) History of cigarette smoking and elevated blood pressure c) Advanced age and low serum total and low-density lipoprotein cholesterol d) High serum high-density lipoprotein and diabetes
b
Which of the following is the difference between the end-diastolic and end-systolic volumes? a) Cardiac output b) Stroke volume c) Ejection fraction d) Cardiac reserve
b
Which serum biomarker is highly specific for myocardial tissue? a) Creatine kinase b) Troponin c) C-reactive protein d) White blood cells
b
What are the physiologic signs and symptoms of cardiogenic shock? (Select all that apply.) a) Hypercapnic lips and nail beds b) Increased extraction of O2 from hemoglobin c) Decrease in mean arterial blood pressures d) Increased urine output related to increased renal perfusion e) Rise in central venous pressure (CVP)
bCE
Which of the following statements regarding heart failure are true? Select all that apply a) Pulmonary hypertension is a frequent cause of left-sided failure. b) In uncompensated left heart failure, there is pulmonary congestion and edema. c) In compensated heart failure, cardiac output is normal. d) Myocardial infarction is a frequent cause of right-sided failure. e) In uncompensated right heart failure, there is peripheral venous congestion and edema.
bCe
The nurse is reviewing the circulatory system. Which statements are correct about the functional organization of the circulatory system? Select all that apply. a) The capillaries pump blood. b) The venous system collects deoxygenated blood from the tissues . c) The arterial system distributes oxygenated blood to the tissues. d) The heart exchanges gases, nutrients and wastes.
bc
A 20-year-old college student being treated for a kidney infection developed a temperature of 104ºF in spite of treatment with antibiotics. Her pulse was high, her blood pressure was low, and her skin was hot, dry, and flushed. The nurse knows that this patient most likely is experiencing which of the following types of shock? a) Anaphylactic b) Neurogenic c) Septic d) Cardiogenic
c
A client with a history of heart failure has been assessed and the care team has determined that a reduction in myocardial workload would benefit his prognosis. Which intervention is most likely to meet this client's needs? a) Regular administration of inotropic drugs b) An implantable defibrillator c) Implantation of a ventricular assist device d) Cardioversio
c
A client with aortic insufficiency is experiencing an increase in afterload. The client will experience fatigue and activity intolerance due to: a) pressure applied to valves. b) residual blood in heart following contraction. c) resistance to ejection of blood from the heart. d) slow ventricular filling.
c
A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms? a) Restlessness and nervousness b) Papilledema and lethargy c) Headache and confusion d) Stupor and hyperreflexia
c
A client with malignant hypertension is at risk for a hypertensive crisis, including the cerebral vascular system often causing cerebral edema. The nurse would assess this client for which signs and symptoms? a) Stupor and hyperreflexia b) Papilledema and lethargy c) Headache and confusion d) Restlessness and nervousness
c
A patient is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension? a) Sustained diastolic pressure of 90-99 mm Hg b) Sustained systolic pressure of 140-159 mm Hg c) Sustained systolic pressure equal to or greater that 160 mm Hg d) Sustained diastolic pressure of 81-89 mm Hg
c
A patient who experienced an ST elevation myocardial infarction (STEMI) received fibrinolytic therapy with streptokinase. Which of the following manifestations alerts the nurse to a developing complication? a) Hypoglycemia b) Diarrhea c) Decreased level of consciousness d) Symmetrical joint pain
c