Patho Test 1 - Cardiovascular System
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) Afterload
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) 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 its healthy to drink a lot of water, and Im 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) I'm trying to think of ways that I can cut down the amount of salt that I usually eat.
What is the correct sequence for blood flow through the heart?
Right atrium - tricuspid valve - right ventricle - pulmonic valve - pulmonary artery - lungs - pulmonary veins - left atrium - mitral valve - left ventricle - aortic valve - aorta
A client has been diagnosed with chronic obstructive arterial disease. Which client statement indicates she understands how to manage this disease? a) "I should have my LDL monitored." b) "I don't need to monitor my blood pressure." c) "Diabetes mellitus has no effect on my condition." d) "I should stay in bed with my legs elevated."
a) "I should have my LDL monitored." Intermittent claudication is the primary symptom of chronic obstructive arterial disease. The two goals of treatment are to decrease their considerable cardiovascular risk and to reduce symptoms. Walking (slowly) to the point of claudication is encouraged because it increases collateral circulation. Addressing blood pressure and high lipid levels are measures to reduce cardiovascular risk. People with diabetes mellitus (DM) develop more extensive and rapidly progressive vascular disease than do people who do not have DM.
A number of patients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention? a) A 69-year-old woman who has entered ventricular fibrillation. b) A 60-year-old woman who has just been diagnosed with a first-degree AV block. c) A 60-year-old man with premature ventricular contractions (PVC) and a history of atrial fibrillation. d) A 46-year-old man whose cardiac telemetry shows him to be in ventricular tachycardia.
a) A 69-year-old woman who has entered ventricular fibrillation. Ventricular fibrillation, or ventricular flutter, is a life-threatening emergency that would necessitate immediate intervention. Ventricular tachydardia is also a serious condition, but less so than ventricular fibrillation. PVCs and a first-degree AV block would not normally require emergency intervention.
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) Acute myocardial infarction. Hypertension is also another major cause of left-sided heart failure. Chronic pulmonary disease and tricuspid valve regurgitation can cause right-sided failure. Impaired renal blood flow can be a consequence rather than a cause of heart failure.
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) Vegetative valve destruction.
The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important intervention for the nurse to implement would be: a) Apply sequential pneumatic compression devices to lower extremities b) Apply ice compresses to the site of the DVT hourly c) Ensure that the client remains on bed rest d) Massage legs to maintain blood flow
a) Apply sequential pneumatic compression devices to lower extremities The application of sequential pneumatic compression devices augments blood flow and reduces stasis. Early ambulation is encouraged. Ice applications would not be recommended due to venous constriction.
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) Atherosclerosis with history of MI
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) Chronic venous insufficiency
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 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) Left ventricular hypertrophy
The nurse knows that factors that affect stroke volume include which of the following? (Select all that apply.) a) Myocardial contractility b) Heart rate c) Preload d) Ventricular automaticity e) Afterload
a) Myocardial contractility c) Preload e) Afterload Stroke volume (the amount of blood ejected with each ventricular contraction) is determined by preload (volume of blood in the left ventricle just before systole), afterload (peripheral vascular resistance) and the force of myocardial contraction. Heart rate will affect cardiac output. Ventricular automaticity (ability of ventricular cells to spontaneously depolarize) does not affect stroke volume but can affect heart rate if the sinoatrial node loses its ability to control the rate of ventricular contraction.
Which of the following factors represents the amount of blood that the heart must pump with each beat and is determined by the stretch of the cardiac muscle fibers and the actions of the heart prior to cardiac contraction? a) Preload b) Afterload c) Cardiac contractility d) Heart rate
a) Preload
A 45-year-old woman with a diagnosis of multiple sclerosis comes to the clinic complaining of coldness and pain in her fingers. She says that her fingers turn blue, and then her fingers get red, and they throb and tingle. The nurse would expect what diagnosis and treatment for this patient? (Select all that apply.) a) Raynaud disease; protecting the digits from cold b) Arterial thrombosis; streptokinase c) Peripheral artery disease; aspirin d) Raynaud phenomenon; stop smoking
a) Raynaud disease; protecting the digits from cold d) Raynaud phenomenon; stop smoking
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) Right-sided heart failure
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) Stable angina
A nurse assesses a patient with normal biomarkers who reports angina. Which of the following additional manifestations are late signs of aortic stenosis? (Select all that apply.) a) Syncope b) Peripheral cyanosis c) Dyspnea d) Hypertension e) Diarrhea
a) Syncope b) Peripheral cyanosis c) Dyspnea The earliest signs of aortic stenosis are a loud systolic ejection murmur or a single or paradoxically split second heart sound. Angina, syncope, and heart failure are later signs of the disorder.
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for: a) Tearing or ripping-type pain in the chest or back b) Tonic-clonic seizures c) Chest pain radiating to the right arm d) Late hypertensive crisis
a) Tearing or ripping-type pain in the chest or back
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) Venous blood return.
The 40-year-old nurse is concerned that her job requires her to stand most of the day. Which of the following therapies could be implemented to prevent tissue injury? a) Wearing correctly fitted, elastic support stockings b) Sclerotherapy c) Application of heat to the legs d) Implementation of warfarin therapy
a) Wearing correctly fitted, elastic support stockings The incidence of varicose veins is more common in females between 30 and 50 years of age and among people who stand for the majority of their day due to an occupation (e.g., nurses). Treatment measures for varicose veins focus on improving venous flow and preventing tissue injury. Support stockings prevent vein distention. Sclerotherapy is used in the treatment of small varicosities. Warfarin therapy and heat application are used to treat deep vein thrombosis.
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) Weight gain.
A nurse will be providing care for a female patient who has a diagnosis of heart failure that has been characterized as being primarily right-sided. Which of the following statements best describes the presentation that the nurse should anticipate? The client: a) has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. b) complains of dyspnea and has adventitious breath sounds on auscultation (listening). c) has cyanotic lips and extremities, low urine output, and low blood pressure. d) has a distended bladder, facial edema, and nighttime difficulty breathing.
a) has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain. Right-sided failure is associated with peripheral edema, fatigue, and, on occasion, upper right quadrant pain. Abdominal distention can occur with right-side failure when the liver becomes engorge. Facial edema, pulmonary edema, peripheral cyanosis, low urine output and low blood pressure are less associated with right-sided failure. Left-sided failure is primarily associated with pulmonary signs/symptoms like dyspnea, pulmonary edema, frothy pink sputum, and respiratory congestion.
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) "You need to increase the amount of exercise you do to get your heart muscle back in shape." b) "This means your heart is not pumping as much blood out of the heart with each beat." c) "This means you have a lot of pressure built-up inside your heart." d) "Your ventricular muscle is getting too stiff to beat normally."
b) "This means your heart is not pumping as much blood out of the heart with each beat." Ejection fraction is the percentage of diastolic volume ejected from the heart [left ventricle] during systole. Stroke volume is determined by the difference between end-diastolic and end-systolic volumes. Cardiac output is determined by stroke volume and heart rate. Cardiac reserve refers to the maximum percentage of increase in cardiac output that can be achieved above the normal resting level
A client with heart disease has the left ventricular ejection fraction measured. What is the normal left ventricular ejection when determined by angiocardiography? a) 45% - 65% b) 55% - 75% c) 65% - 85% d) 35% - 55%
b) 55% - 75% Ejection fraction is the percentage of blood that the left ventricle pumps out with each contraction.
When trying to educate a patient about the release of free radicals and the role they play in formation of atherosclerosis, which of the following statements is most accurate? a) Activated cells roam the vascular system looking for inflammatory cells to engulf. b) Activated cells that release free radical oxidize LDL which is harmful to the lining of your blood vessels. c) Oxidized free radicals product toxic metabolic waste that can kill liver cells. d) The end result of oxidation is rupture of the plaque resulting in hemorrhage.
b) Activated cells that release free radical oxidize LDL which is harmful to the lining of your blood vessels.
The nursing instructor, when teaching the students about coronary artery disease (CAD), identifies which of the following as the the main cause of CAD? a) Excessive use of dairy products b) Atherosclerosis c) Defect in the DNA d) Excessive exercise
b) Atherosclerosis In most cases, coronary artery disease is caused by atherosclerosis. Exercise is good for people and excessive use of dairy is not related nor is it a defect in DNA. Risk factors can predispose someone to coronary artery disease such as cigarette smoking, high cholesterol, diabetes, advancing age, etc.
A 70-year-old male client presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which of the following medical diagnosis/possible treatment plan listed below? a) Raynaud disease that will require antiplatelet medications b) Atherosclerotic occlusive disease necessitating thrombolytic therapy c) Giant cell temporal arteritis that will be treated with corticosteroids d) Acute arterial occlusion that will be treated with angioplasty
b) Atherosclerotic occlusive disease necessitating thrombolytic therapy
Cardiac output (CO) is used to measure the efficiency of the heart as a pump. What is the equation used to express CO? a) CO = HR x AV b) CO = SV x HR c) CO = AV x SV d) CO = HR x EF
b) CO = SV x HR Cardiac output is equal to the stroke volume x heart rate and is the amount of blood the heart pumps each minute.
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) Calf pain.
A group of nursing students is discussing ventricular arrhythmias and one student is unsure why a client with frequent premature ventricular complexes (PVCs) has an irregular radial pulse. One of the other students explains that premature ventricular complexes often do not produce a palpable pulse due to: a) Weakness of the ventricle. b) Decreased ventricular filling time. c) Ventricular compensatory pause. d) Recurrent ventricular pathways.
b) Decreased ventricular filling time.
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) ECG changes.
During assessment of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. Which aspects of the pathophysiology of aneurysms would the healthcare provider explain to this client? a) Aneurysms are commonly a result of poorly controlled diabetes mellitus. b) Hypertension is a frequent modifiable contributor to aneurysms. c) Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures. d) Aneurysms can normally be resolved with lifestyle and diet modifications
b) Hypertension is a frequent modifiable contributor to aneurysms. Hypertension is associated with over half of aneurysms. They are not consequences of diabetes, and while some are asymptomatic in early stages, this is not necessarily the norm and does not necessarily culminate in a rupture. Aneurysms normally require surgical repair.
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) Large lipid core.
A client is very much concerned about his family history of atherosclerosis and asks the nurse if there is anything he can do to decrease his risk. The client has type 2 diabetes. The best response would be: (Select all that apply.) a) Decrease smoking b) Maintain normal weight c) Control hypertension d) Control blood glucose levels e) Increase LDL levels
b) Maintain normal weight c) Control hypertension d) Control blood glucose levels The major risk factors that can be modified by a change in health care behaviors include cigarette smoking, obesity, hypertension, hyperlipidemia and elevated LDL cholesterol, and diabetes mellitus, all of which are traditional cardiovascular risk factors. Cigarette smoking must be stopped not decreased.
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) Frequent angina b) Orthopnea c) Exertional dyspnea d) Palpitations e) Paroxysmal nocturnal dyspnea
b) Orthopnea c) Exertional dyspnea d) Palpitations e) Paroxysmal nocturnal dyspnea As aortic regurgitation progresses, signs and symptoms of left ventricular failure begin to appear. These include exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Angina is a rare symptom. Tachycardia, occurring with emotional stress or exertion, may produce palpitations, head pounding, and premature ventricular contractions.
A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for: a) Arterial insufficiency b) Pulmonary embolism c) Polyarteritis nodosa d) Vasculitis
b) Pulmonary embolism Deep venous thrombosis (DVT) most commonly occurs in the lower extremities. DVT of the lower extremity is a serious disorder, complicated by pulmonary embolism, recurrent episodes of DVT, and development of chronic venous insufficiency. Isolated calf thrombi often are asymptomatic. If left untreated, they may extend to the larger, more proximal veins, with an increased risk of pulmonary emboli.
A 56-year-old woman presents at the clinic complaining of the unsightliness of her varicose veins and wants to know what can be done about them. The nurse explains that the treatment for varicose veins includes which of the following interventions? a) Surgical or fibrotherapy b) Sclerotherapy or surgery c) Trendelenburg therapy or sclerotherapy d) Surgery or Trendelenburg therapy
b) Sclerotherapy or surgery
An IV drug abuser walks into the ED telling the nurse that, "they are sick." They look feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and, fatigued. The assessment reveals a loud murmur. An echocardiogram was order that shows a large vegetation growing on their mitral valve. The patient is admitted to ICU. The nurse will be assessing this patient for which possible life-threatening complication? a) Petechial hemorrhages under the skin and nail beds. b) Systemic emboli, especially to brain. c) GI upset from the massive amount of antibiotics required to kill the bacteria. d) Pancreas enlargement due to increased need for insulin secretion.
b) Systemic emboli, especially to brain. Systemic emboli and develop and break off the mitral valve and travel into the vascular system. There is a high probability that the emboli could lodge in the brain, kidneys, lower extremities, etc. B—petechial hemorrhages are s/s of IE. GI upset is common following antibiotic therapy but is not usually life-threatening. Stress can increase insulin needs but not associated with pancreas enlargement.
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) Thrombosis
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) Microemboli being developed in the carotids by Staphylococcus epidermidis b) Vegetative emboli traveling in the blood stream to the lungs c) Blood clots in the left ventricle traveling through the aorta d) Infarction of the tissue surrounding the endocardium of the heart
b) Vegetative emboli traveling in the blood stream to the lungs The client is exhibiting signs of pulmonary emboli. The infectious loci continuously release bacteria into the bloodstream and are a source of persistent bacteremia, sometimes contributing to pericarditis. As the lesions grow, they cause valve destruction and dysfunction such as regurgitation, ring abscesses with heart block, and perforation. The loose organization of these lesions permits the organisms and fragments of the lesions to form emboli and travel in the bloodstream, causing cerebral, systemic, or pulmonary emboli. If clots are in the left ventricle, they will travel to the brain or kidneys. If emboli are located in the carotids, they will travel to the brain tissue. Infarction of heart tissue will exhibit signs of a myocardial infarction, not pulmonary emboli.
A patient in the nursing home wonders why he is having these signs and symptoms of left-sided failure. Which of the following explanations will the nurse give the patient? a) "The left ventricle is pumping excessive amounts of blood through the carotid arteries causing headache." b) "The left ventricle is not adequately perfusing your gastrointestinal tract, leading to diarrhea and vomiting." c) "The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs." d) "The left ventricle is having problems pumping blood forward so blood is backing up systemically causing edema in your feet."
c) "The left ventricle is having problems pumping blood forward, and this is causing blood to back up into your lungs." In left-sided failure, the left ventricle pumps inefficiently, blood backs up in the pulmonary circulation, and less, rather than more, blood enters the carotid arteries. Right-sided rather that left-sided failure causes blood to back up in the venous circulation resulting in edema. Congestion of the gastrointestinal tract is usually characteristic of advanced heart failure.
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) A pulsating mass.
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) Acute ventricular arrhythmia.
The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope? a) At the carotid arteries b) Over the aorta c) At the apex of the heart d) Over the sternum
c) At the apex of the heart The murmur of mitral valve stenosis is heard during diastole when blood is flowing through the constricted valve; it is characteristically a low-pitched, rumbling murmur best heard at the apex of the heart. The other locations would not be effective.
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) Coronary perfusion.
The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be: a) Decreased retention of sodium b) Increased ejection fraction c) Decreased cardiac output d) Increased renal blood flow
c) Decreased cardiac output In heart failure with a reduced ejection fraction, a decrease in cardiac output and renal blood flow leads to increased sodium and water retention by the kidney with a resultant increase in vascular volume and venous return to the heart and an increase in ventricular end-diastolic volume.
A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the department would most realistically anticipate which of the following sets of diagnostics? a) Cardiac catheterization, chest X-ray, electrolyte measurement, and white cell count b) CT of the heart, chest X-ray, ECG c) Echocardiogram, blood cultures, temperature d) ECG, blood pressure, stress test
c) Echocardiogram, blood cultures, temperature An echocardiogram would help visualize the heart, while blood cultures would confirm the presence or absence of microorganisms in circulation and temperature would gauge the presence of infection. A chest X-ray, blood pressure measurement and cardiac catheterization would be less likely to indicate infective endocarditis.
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) Advanced age and low serum total and low-density lipoprotein cholesterol b) High serum high-density lipoprotein and diabetes c) History of cigarette smoking and elevated blood pressure d) Physical inactivity and high serum high-density lipoprotein cholesterol
c) History of cigarette smoking and elevated blood pressure The major risk factors for CAD include cigarette smoking, elevated blood pressure, elevated LDL cholesterol, low HDL cholesterol, diabetes, advancing age, abdominal obesity, and physical inactivity.
The diagnosis is right-sided heart failure. The nurse knows that which organ is primarily affected in this type of heart failure? a) Gastrointestinal tract b) Kidneys c) Liver d) Jugular veins
c) Liver As right-sided heart failure occurs, blood backs up in the venous circulation including the hepatic veins that drain into the inferior vena cava. The liver becomes engorged, and with prolonged right-sided failure, hepatic cell death occurs. The kidneys are further down in the venous circulation and are less affected. The jugular veins and gastrointestinal tract are affected, but are not organs.
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) Vertigo, headache b) Weakness, palpitations c) Peripheral edema, weight gain d) Dyspnea, cough
c) Peripheral edema, weight gain In right failure. blood backs up into the venous side of the circulatory system causing increased hydrostatic pressure in capillaries and leakage of plasma which forms peripheral edema and becomes apparent as weight gain. The other manifestations listed are not characteristic of right-sided failure.
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) Preload
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 incompetent, thereby allowing blood to flow back from the pulmonary artery and into the left atrium. b) The valve opening permits backward flow to occur when the valve should be closed. c) The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. d) The valve opens backward permitting blood to flow from the right ventricle into the right atrium.
c) The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta. Stenosis refers to a narrowing of the valve orifice and failure of the valve leaflets to open normally. This increases the work and volume of the chamber emptying through the narrowed valve—the left atrium in the case of mitral stenosis and the left ventricle in aortic stenosis. An incompetent or regurgitant valve permits backward flow to occur when the valve should be closed—flowing back into the left ventricle during diastole when the aortic valve is affected and back into the left atrium during systole when the mitral valve is diseased.
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) Ventricular repolarization The T wave represents repolarization of the ventricles.
Which of the following types of aortic aneurysms is the most common? a) Ascending aorta b) Aortic arch c) Thoracic d) Abdominal aortic
d) Abdominal aortic
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) Anticoagulation therapy and elevation of the leg Answer choice C would not be correct because those interventions are used to prevent a DVT from developing, not to treat a DVT once it has formed.
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) Backflow from the left ventricle to left atrium
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) C-reactive protein
An elderly patient arrives to the healthcare provider's office complaining of a "sore" that won't heal on their lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the patient that the usual treatment is: a) Initiation of Coumadin therapy to maintain an INR of 2-3.0 above norm. b) Hydrotherapy treatments to facilitate improvement in circulation. c) Long-term antibiotic therapy to facilitate healing of the wound. d) Compression therapy to help facilitate blood flow back to the vena cava.
d) Compression therapy to help facilitate blood flow back to the vena cava.
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) Deep vein thrombosis.
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be: a) 55 years of age b) Being male c) Family history of heart disease d) Hypertension
d) Hypertension
Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells? a) Hyperplasia b) Dysplasia c) Atrophy d) Hypertrophy
d) Hypertrophy Myocardial hypertrophy is a compensatory mechanism in heart failure as the heart attempts to maintain adequate pumping ability. Paradoxically, hypertrophy can gradually decrease cardiac efficiency.
A client has just been told that he has an infection of the inner surface of the heart. He is also told that the bacteria has invaded his heart valves. What term is used for this disease process? a) Cardiomyopathy b) Myocardial infarction c) Pericarditis d) Infective endocarditis
d) Infective endocarditis Infective endocarditis is a serious and potentially life-threatening infection of the inner surface of the heart. Pericarditis involves an inflammatory response of the pericardium. Myocardial infarction is a heart attack while cardiomyopathy is a heart disorder that is confined to the myocardium and can sometimes represent myocardial changes that occur with a variety of systemic disorders.
A client who has just been diagnosed with mitral valve stenosis tells the nurse that he has heard of the disease but he does not know anything about it. He asks the nurse what it means. What would be the nurse's best response? a) It is a defect of the mitral valve which allows for back flow of blood. b) It is an inflammatory process of the mitral valve. c) It is a disorder of the mitral valve caused by atherosclerosis. d) It is a defect of the mitral valve which causes obstruction of blood flow.
d) It is a defect of the mitral valve which causes obstruction of blood flow. Mitral valve stenosis is a defect of the mitral valve which causes obstruction of blood flow, while mitral valve regurgitation is characterized by incomplete closure of the mitral valve and blood moves backward into the left atrium.
Which of the following individuals is at greatest risk for developing a venous thrombosis resulting from venous stasis? a) Dehydrated patient b) Client in the terminal stage of cancer c) Pregnant woman d) Patient on bed rest
d) Patient on bed rest Bed rest or immobility causes a pooling of blood in the legs resulting in venous stasis. The other individuals are at risk for hyperreactive blood coagulation that can also result in venous thrombosis.
Venous thrombosis most commonly occurs in the lower extremities. Risk factors for venous thrombosis include which of the following? a) Stasis of blood, hypercoagulability, inflammation b) Hypocoagulability, vessel wall injury, increased pressure on deep veins c) Vessel wall injury, hypocoagulability, decreased venous blood flow d) Stasis of blood, hypercoagulability, vessel wall injury
d) Stasis of blood, hypercoagulability, vessel wall injury This is known as Virchow's Triad.
A client has just been admitted to the cardiac intensive care unit with a diagnosis of infective endocarditis. His wife appears distraught and asks the nurse what caused this to happen to her husband. What would be the nurse's best response? a) Let's not worry about the cause as we need to focus on getting him better. b) It can be attributed to drug abuse. c) Sometimes a parasite is involved. d) The most common cause is a staph infection.
d) The most common cause is a staph infection. Staphylococcal infections have now emerged as the leading cause of infective endocarditis, with streptococci and enterococci as the other two most common causes. Informing the client's wife about the drug abuse connection infers that you think he is a drug addict and is not therapeutic. Parasites are never the cause and telling the patient to focus on her husband also is not appropriate as this is a genuine concern for her.
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) Vasospasm; inflammation.
Which of the following statements about vascular compliance is accurate? a) A continuous flow through the capillaries occurs primarily during systole. b) Arteries are much more distensible than veins. c) Arteries have thick muscular walls that constrict tightly, thereby ejecting blood without storing it for later use. d) Veins can act as a reservoir for storing large quantities of blood.
d) Veins can act as a reservoir for storing large quantities of blood. The most distensible of all vessels are the veins, which can increase their volume with only slight changes in pressure, allowing them to function as a reservoir for storing large quantities of blood that can be returned to the circulation when it is needed. Although arteries have a thicker muscular wall than veins, their distensibility allows them to store some of the blood that is ejected from the heart during systole, providing for continuous flow through the capillaries as the heart relaxes during diastole.
