Chapter 14 Clinical Presentation and Management of the Cardiac Patient
32) What is the term for inadequate flow of arterial blood, typically as a result of left ventricular failure? A) Cardiogenic shock B) Anaphylactic shock C) Hypovolemic shock D) Neurogenic shock
Answer: A Explanation: Cardiogenic shock is caused by inadequate flow of arterial blood, typically as a result of left ventricular failure.
55) What is the term for a medication that is administered intravenously to convert plasminogen to plasmin, which then breaks down the fibrin in a clot? A) Thrombolytic agent B) Anticoagulant C) Fluorescent dye D) Bolus
Answer: A Explanation: A thrombolytic agent works by converting plasminogen to the natural fibrinolytic agent plasmin. Plasmin lyses clots by breaking down the fibrin they contain.
22) A patient with diabetes is how many times more likely than patients without diabetes to experience a heart attack? A) Two times B) Three times C) Five times D) Ten times
Answer: A Explanation: Because of the damage to the blood vessels, a patient with diabetes is twice as likely to experience a heart attack or stroke as patients who do not have diabetes.
29) Which of the following changes does not typically occur in an ECG tracing with a STEMI? A) Absence of P waves B) T wave inversion C) Development of a pathologic Q wave D) ST segment depression or elevation
Answer: A Explanation: Changes to an ECG tracing with a STEMI include ST segment depression or elevation, T wave inversion, and development of a pathologic Q wave. Absence of P waves is not seen on an ECG tracing with a STEMI.
23) What is the term for fatty deposits accumulated by elevated glucose levels? A) Atherosclerotic plaque B) Antigens C) Ascites D) Angiographic plaque
Answer: A Explanation: Elevated glucose levels lead to an accumulation of atherosclerotic plaque.
45) Which of the following is not a common cause of left ventricular heart failure? A) Right ventricular heart failure B) Hypertension C) Atrial fibrillation D) STEMI
Answer: A Explanation: Left ventricular heart failure is the most common cause of right ventricular failure; right ventricular failure is generally not a cause of left ventricular failure, however. Common causes of left ventricular failure include STEMI, hypertension, and cardiac dysrhythmias, such as atrial fibrillation.
43) What is a typical cause of NSTEMI? A) An incomplete occlusion of a coronary artery B) Sudden, complete blockage due to thrombosis C) Chronic left ventricular failure D) Bundle branch block
Answer: A Explanation: NSTEMI often occurs because of an incomplete occlusion of a coronary artery.
2) Which of the following is one of the primary branches of the left coronary artery and winds around, supplying blood to the lateral wall of the left ventricle? A) Circumflex artery B) Posterior descending artery C) Left anterior descending artery D) Anterior interventricular artery
Answer: A Explanation: The circumflex artery is one of the primary branches of the left coronary artery; it winds around, supplying blood to the lateral wall of the left ventricle.
50) You are preparing Mrs. Bayfield for percutaneous coronary intervention. As you explain the procedure to her, she states, "They are going to put a stent in my heart, so why do they need to inject dye in my arm?" What should you tell Mrs. Bayfield? A) The dye is used to find the exact location of the blockage. B) The dye contains Coumadin, which will make the blood flow more freely. C) The dye is a precaution to help the surgeon avoid nearby nerve endings. D) The dye is an indicator that changes color when blood flow is restored.
Answer: A Explanation: The dye is injected for fluoroscopic examination of the arteries to determine the specific location of a narrowed or occluded artery.
7) What is the middle layer of a blood vessel called? A) Tunica media B) Tunica adventitia C) Tunica intima D) Tunica fascia
Answer: A Explanation: The middle layer of a blood vessel is the tunica media.
37) The mnemonic O-P-Q-R-S-T helps health care professionals remember the questions to ask when evaluating which of the following? A) Pain or discomfort the patient is experiencing B) Additional medical information C) Patient demographics D) Patient's family history
Answer: A Explanation: The mnemonic O-P-Q-R-S-T is a memory device to help recall the questions to ask when evaluating a patient's pain or discomfort. Each letter corresponds with a specific question related to the patient's having pain.
8) What is the function of the tunica media? A) Dilate and constrict to maintain homeostasis B) Keep the vessel open C) Allow medications to pass through D) Come in direct contact with the blood
Answer: A Explanation: The tunica media consists of smooth muscle. Its job is to dilate and constrict to help maintain normal blood pressure, thus maintaining homeostasis.
17) Unstable angina is a warning sign that a patient's cardiac disease has ________. A) Worsened B) Remained stable C) Resulted in decreased cardiac output D) Developed into a dysrhythmia
Answer: A Explanation: Unstable angina is a warning sign that a patient's cardiac disease has worsened and may indicate acute coronary syndrome.
64) The patient with chest pain will be going for a cardiac catheterization and the following orders have not been completed. Which one should be done last? A) administer morphine B) start an intravenous line C) administer nitroglycerin D) obtain a signed content
Answer: A Explanation: Vital signs and a 12-lead ECG must be done immediately. An intravenous line is started to administer medications such as nitroglycerin and morphine. A signed consent must be obtained before the patient receives a narcotic such as morphine, and morphine is typically not given until after it is determined that chest pain is not relieved by nitroglycerin.
49) When angioplasty is performed on a coronary vessel, a stent is typically inserted to do what? A) Repair the vessel walls B) Help prevent restenosis C) Reroute blood flow away from the surgical site D) Prevent excess bleeding from the surgical site
Answer: B Explanation: Angioplasty alone has a chance of restenosis, or returning to the blocked state. A stent is typically inserted during the angioplasty procedure to help hold the artery open.
26) Approximately what percentage of elderly patients present with atypical cardiac symptoms? A) 25% B) 50% C) 75% D) 90%
Answer: B Explanation: Approximately 50% of elderly patients with an acute coronary syndrome reported atypical symptoms. Elderly patients are likely to experience milder symptoms.
21) Which of the following are common cardiac symptoms in women? A) Migraine headaches B) Unusual fatigue and cold sweats C) Leg pain and edema D) Bloating
Answer: B Explanation: Cardiac symptoms are less predictable in women than men. Women are more likely than men to experience some of the other common symptoms, particularly shortness of breath, weakness, cold sweats, and unusual fatigue.
56) For which of the following patients is fibrinolytic therapy not appropriate? A) A 44-year-old male patient with suspected coronary occlusion B) A 52-year-old female patient with a blood pressure of 160/110 mmHg C) A 36-year-old female cardiac patient who lives in a rural area D) A 47-year-old male patient with a blood pressure of 110/54 mmHg
Answer: B Explanation: Contraindications for the administration of thrombolytic or fibrinolytic agents include intracranial hemorrhage, stroke, or head trauma within the previous 3 months; bleeding disorders; bleeding ulcers; pregnancy; uncontrolled high blood pressure; and recent trauma or surgery. Thus, of these patients, the 52-year-old woman with a high blood pressure of 160/110 mmHg would not be an appropriate candidate for fibrinolytic therapy.
59) Which of the following procedures is a reasonable alternative for a patient who has had heart failure and is not strong enough to withstand heart catheterization? A) Percutaneous coronary intervention B) Enhanced external counter pulsation C) Percutaneous transluminal coronary intervention D) Coronary artery bypass graft surgery
Answer: B Explanation: Enhanced external counter pulsation is a safe, noninvasive, well-tolerated, and clinically effective outpatient physical therapy treatment that can be used on patients who are not strong enough to withstand heart catheterization or heart surgery.
41) Which of the following is one reason heart disease is slightly more common in men than in women? A) Women have a faster basal heart rate. B) Hormones produced during the childbearing years reduce the risk in women. C) Women generally handle stress better than men. D) Women are more active and exercise more frequently than men.
Answer: B Explanation: Protective hormones produced during the childbearing years help reduce the risk of cardiac problems in women.
62) Which of the following memory tools is useful for gathering information regarding oral intake? A) ABCDE B) SAMPLE C) OPQRST D) ACLS
Answer: B Explanation: SAMPLE is used for evaluating patients. The letter L indicates to evaluate the last intake which includes food or liquids, when they were eaten, and how much.
44) When might sudden cardiac arrest occur? A) When a portion of the heart does not receive enough oxygen B) When the heart's electrical system fails, often without warning C) When the heart is unable to pump a sufficient amount of blood to body tissues D) When a coronary artery becomes completely occluded
Answer: B Explanation: Sudden cardiac arrest occurs when the heart suddenly stops beating, frequently without warning, due to a failure of its electrical system.
12) The average person waits how many hours before seeking help for symptoms of a heart attack? A) 1 hour B) 3 hours C) 12 hours D) 24 hours
Answer: B Explanation: The National Institutes of Health's National Library of Medicine (Medline-Plus) estimates that the average person waits 3 hours before seeking help for symptoms of a heart attack.
51) A patient has been brought to the emergency department complaining of chest pain and dizziness. When assessing this patient, what should the health care professional do? A) Take extra time to ensure complete accuracy of the information obtained. B) Gather information quickly and efficiently and report it immediately to the physician. C) Do a cursory assessment only because the patient needs immediate treatment. D) Wait to do the assessment until after a stent has been inserted.
Answer: B Explanation: The information must be efficiently gathered, recorded, and/or reported to the physician or treating practitioner. Both speed and accuracy are critical.
5) What is the outermost layer of a blood vessel called? A) Tunica media B) Tunica adventitia C) Tunica intima D) Tunica fascia
Answer: B Explanation: The outermost layer of a blood vessel is the tunica adventitia.
1) Which of the following is one of the primary branches of the right coronary artery, providing blood to the posterior wall of the heart? A) Circumflex artery B) Posterior descending artery C) Left anterior descending artery D) Anterior interventricular artery
Answer: B Explanation: The posterior descending artery is one of the primary branches of the right coronary; it provides blood to the posterior wall of the heart.
6) What is the function of the tunica adventitia? A) Dilate and constrict to maintain homeostasis B) Keep the vessel open C) Allow medications to pass through D) Come in direct contact with the blood
Answer: B Explanation: The tunica adventitia consists of tough, fibrous connective tissue that keeps the vessel open.
34) What is the term for an abnormal collection of fluid in the lungs due to left ventricular failure? A) Pulmonary hypertension B) Pulmonary edema C) Pulmonary embolism D) Pulmonary necrosis
Answer: B Explanation: When the left ventricle fails, blood stalls and backs up in the lungs, often causing pulmonary edema.
19) Which three groups of patients may present with atypical cardiac complaints or problems? A) Patients with diabetes, patients who smoke, and patients who abuse drugs B) Women, the elderly, patients with diabetes C) African Americans, teenagers, patients who smoke D) Children, patients with cancer, the elderly
Answer: B Explanation: Women, patients with diabetes, and the elderly often present with atypical cardiac complaints or problems.
54) What is the term for a concentrated amount of medication administered over a short period of time? A) Stent B) Catheter C) Bolus D) Thrombus
Answer: C Explanation: A bolus is a concentrated amount of medication or fluid administered over a prescribed short period of time.
60) Which of the following patients is the most likely candidate for a left ventricular assist device (LVAD)? A) A 42-year-old woman with uncontrolled hypertension B) A 67-year-old man with partial blockage of two coronary arteries C) A 49-year-old woman in end-stage heart failure D) A 56-year-old man with extensive disease in the left main coronary artery
Answer: C Explanation: A left ventricular assist device (LVAD) is a mechanical, battery-powered device that is surgically implanted in a patient's chest to help the left ventricle pump blood throughout the body. It is an option for patients with end-stage heart failure and are waiting for a heart transplant, as well as for people who are not strong enough to endure a heart transplant.
20) What percentage of women who are having a heart attack never experience chest pain? A) 10% B) 25% C) 37% D) 75%
Answer: C Explanation: According to the Journal of the American Medical Association (JAMA), 37% of women having a heart attack never experience chest pain.
42) What is the broad term that refers to STEMI, NSTEMI, and unstable angina? A) Thrombosis B) Coronary plaque C) Acute coronary syndrome D) Chronic heart failure
Answer: C Explanation: Acute coronary syndrome refers to unstable angina, STEMI, and NSTEMI and is usually associated with intracoronary plaque changes or thrombosis, where blood flow is suddenly stopped.
13) What is the term for an oppressive pain or pressure in the chest that occurs when the heart muscle does not receive enough oxygen due to partial or complete blockage of a coronary artery? A) Apnea B) Asystole C) Angina D) Arrhythmia
Answer: C Explanation: Angina is an oppressive pain or pressure in the chest that occurs when the heart muscle does not receive enough oxygen due to partial or complete blockage of a coronary artery.
35) Which of the following are not symptoms of left ventricular failure? A) Shortness of breath, fatigue, and tachycardia B) Confusion and anorexia C) Hypertension and increased thirst D) Decreased urine production and pallor
Answer: C Explanation: Common signs and symptoms of left ventricular failure include shortness of breath or trouble breathing, fatigue, tachycardia, confusion, anorexia, decreased or absent urine production, and pallor. Hypertension and increased thirst are not symptoms of left ventricular failure.
57) For which of the following conditions might Coumadin be prescribed for a patient? A) Hypovolemia B) Hypertension C) Hypercoagulopathy D) Hypotension
Answer: C Explanation: Coumadin is prescribed to treat heart rhythm disturbances, such as atrial fibrillation, or to treat hypercoagulopathy, in which the blood has an increased ability to form clots.
16) Which of the following are not symptoms that may occur due to blockage of the coronary arteries? A) Shortness of breath, sweating, and chest pain B) Neck pain, cough, and back pain C) Edema and decreased urinary output D) Dizziness, nausea, and arm pain
Answer: C Explanation: Edema and decreased urinary output are not symptoms of coronary artery blockage. The following is a list of complaints that may occur due to blockage of the coronary arteries: shortness of breath, sweating, chest pain, epigastric discomfort, neck pain, cough, back pain, squeezing sensation, dizziness, pressure in the chest, nausea, fullness in the chest, tight band around the chest, palpitations, anxiety, sense of impending doom, jaw pain, and arm pain.
52) A patient is brought to the emergency department by ambulance. He is having severe chest pain that is radiating through his left arm and is having difficulty breathing. You suspect that the patient will be rushed into surgery soon. What must you do before the patient is given narcotics for the pain? A) Check and record the patient's blood pressure. B) Inform the patient's family that surgery is likely. C) Have the patient sign a consent form. D) Administer oxygen to the patient.
Answer: C Explanation: If there is a possibility that the patient will be undergoing an invasive procedure, an operative permit or consent must be signed before any narcotic is administered. Informed consent is violated if the patient is chemically impaired from a narcotic when signing this document.
24) What condition caused by chronic diabetes impairs sensations or causes a loss of sensation? A) Neuroblastoma B) Neuralgia C) Neuropathy D) Nephritis
Answer: C Explanation: Neuropathy may cause vascular and autonomic nervous system problems accompanied by loss of ability to maintain blood pressure and loss of or impaired sensation.
65) Which chambers or surfaces of the heart are at risk for infarction with a "widow maker"? A) Right and left ventricles B) Right ventricle, posterior surface and septum C) Anterior, lateral and septal surfaces of the left ventricle D) Left ventricle and both atria
Answer: C Explanation: Occlusion of the proximal left main coronary artery leads to cardiogenic shock and sudden death and is often referred to as the "widow maker." Occlusion of this vessel will lead to death of the septum and the anterior and lateral walls of the left ventricle.
15) Which of the following conditions is not a common source of noncardiac chest pain? A) Inflammation of the lungs B) Gastric or esophageal irritation C) Cirrhosis of the liver D) Gallbladder pain
Answer: C Explanation: Patients may experience noncardiac chest pain due to inflammation of the costal cartilage or lungs, gastric or esophageal irritation, gallbladder pain, or dental pain. Cirrhosis of the liver does not typically cause chest pain.
48) Emergency test results indicate that Mr. Hartman has had an MI due to 90% occlusion of the right coronary artery. The physician has determined that a procedure needs to be performed immediately to open the artery. Which of the following procedures is the physician most likely to order for Mr. Hartman? A) Coronary artery bypass graft surgery B) Enhanced external counter pulsation therapy C) Percutaneous transluminal coronary angioplasty D) Thrombolytic therapy
Answer: C Explanation: Percutaneous transluminal coronary angioplasty is angioplasty that is performed specifically on coronary vessels. It is usually performed within 90 minutes of the patient's arrival at the hospital and no more than 12 hours after a heart attack.
27) Which of the following is referred to as the "classic MI"? A) Acute coronary syndrome MI B) Non-STEMI C) STEMI D) Pathologic Q wave MI
Answer: C Explanation: STEMI is referred to as the classic MI.
61) Which of the following memory tools is useful for gathering information regarding pain a patient is experiencing? A) ABCDE B) SAMPLE C) OPQRST D) ACLS
Answer: C Explanation: The O-P-Q-R-S-T mnemonic will help you evaluate the pain or discomfort a patient is experiencing. Each letter corresponds to a question related to the patient's pain level: O - Onset, P - Provoke, Q - Quality, R - Radiation, S - Severity, T - Time.
38) What is the S-A-M-P-L-E mnemonic used for? A) Obtaining an insurance referral B) Gathering information about the patient's family history C) Gathering additional medical information D) Determining the patient's pain level
Answer: C Explanation: The S-A-M-P-L-E memory tool is a prompt to gather additional medical information: symptoms, allergies, medications, previous cardiac history, last intake of food or beverage, and events leading up to the problem.
63) How many 81-mg aspirin are typically ordered for administration to the chest pain patient? A) None B) 1 C) 2-4 D) 5-6
Answer: C Explanation: The doctor will order either a 325-mg tablet or two to four 81-mg chewable baby aspirin tablets.
9) What is the innermost layer of a blood vessel called? A) Tunica media B) Tunica adventitia C) Tunica intima D) Tunica fascia
Answer: C Explanation: The innermost layer of a blood vessel is the tunica intima.
4) Which of the following is one of the primary branches of the right coronary artery and supplies blood to the walls of the right atrium and the right ventricle? A) Circumflex artery B) Posterior descending artery C) Marginal artery D) Left anterior descending artery
Answer: C Explanation: The marginal artery is one of the primary branches of the right coronary artery; it supplies blood to the walls of the right atrium and the right ventricle.
33) What is the most common cause of heart failure? A) Dysrhythmias B) Ischemia C) MI D) Diabetes
Answer: C Explanation: The most common cause of heart failure is MI.
46) Which of the following is a common cause of right ventricular heart failure? A) Atrial tachycardia B) Ventricular fibrillation C) Chronic lung disease D) Gallbladder disease
Answer: C Explanation: The most common cause of right ventricular heart failure is left ventricular heart failure. Other common causes include coronary artery disease and chronic lung disease.
11) Which layer of a blood vessel is prone to disruption when atherosclerotic plaque is ruptured and peels away? A) Tunica media B) Tunica adventitia C) Tunica intima D) Tunica fascia
Answer: C Explanation: The tunica intima is a single-cell layer of endothelial cells that is normally very smooth; this delicate layer is prone to disruption when atherosclerotic plaque is ruptured and peels away.
31) Why does non-STEMI present a challenge to the health care team? A) The patient often mistakes the symptoms for indigestion. B) The ECG tracing looks similar to that of a patient with complete heart block. C) The ECG tracing does not reflect ST segment deviation or presence of a pathologic Q wave. D) There is no conclusive method to determine whether an MI has occurred.
Answer: C Explanation: With non-STEMI, the patient is often asymptomatic but will have vague symptoms. The 12-lead ECG will not display the classic MI morphologic changes. Blood tests must be performed to determine the presence of enzymes in the blood as a result of infarction.
14) Approximately how many people in the United States suffer from angina? A) 10,000 B) 1 million C) 3 million D) 7 million
Answer: D Explanation: According to the National Heart, Blood, and Lung Institute, experts believe that nearly 7 million people in the United States suffer from angina.
47) What minimally invasive procedure is frequently performed to open narrowed or blocked blood vessels? A) Thromboplastic surgery B) Angiography C) Venostasis D) Angioplasty
Answer: D Explanation: Angioplasty is a minimally invasive procedure performed to open narrowed or blocked blood vessels.
58) Which of the following foods would be restricted in a patient's diet while he or she is taking Coumadin? A) Apples B) Onions C) Bell peppers D) Spinach
Answer: D Explanation: Because vitamin K reduces the effectiveness of Coumadin, patients on Coumadin therapy should restrict their intake of foods that are high or moderately high in vitamin K, including spinach, kale, broccoli, turnips, romaine lettuce, and collard greens. Apples, onions, mushrooms, and bell peppers are all low in vitamin K.
30) What percentage of patients present with STEMI? A) Less than 10% B) 20% to 25% C) 40% to 50% D) 75% to 80%
Answer: D Explanation: Between 75% and 80% of patients with MI present with STEMI.
39) Which procedure allows visualization of the coronary arteries and placement of a stent? A) Echocardiography B) Enhanced external counter pulsation C) Coronary artery bypass D) Cardiac catheterization
Answer: D Explanation: Cardiac catheterization is the procedure that allows visualization of the coronary arteries so angioplasty can be done or a stent can be placed inside the coronary artery.
66) Which of the following therapeutic measures may be performed on patients with recurrent angina or on heart failure patients who are typically not strong enough to withstand major surgery? A) CABG B) Balloon angioplasty and stent C) Stent only D) EECP
Answer: D Explanation: External counter pulsation therapy may be performed on patients with recurrent angina or, more recently, on heart failure patients who are typically not strong enough to withstand major surgery such as heart catheterization or CABG.
53) Treatment for hypovolemia may include which of the following therapies? A) Aspirin administration B) Nitroglycerin administration C) Pacemaker insertion D) IV fluid challenge
Answer: D Explanation: Hypovolemia, or low blood volume, may require the administration of an IV fluid challenge or bolus as a volume expander.
36) What three symptoms, when presented together, are known as the "clinical triad" and are indicative of right ventricular failure? A) Shortness of breath, chest pain, and confusion B) Rales, tachycardia, and anorexia C) Ascites, edema, and pallor D) Jugular vein distention, hypotension, and normal breath sounds
Answer: D Explanation: Jugular vein distention, hypotension, and normal breath sounds are known as the clinical triad and are indicative of right ventricular failure. They are considered ominous when presented together.
40) What is Coumadin used for? A) To increase the activity of vitamin K B) To promote the growth of new collateral blood vessels C) To prevent restenosis of a blood vessel D) To reduce clot formation in the blood
Answer: D Explanation: Patients are prescribed Coumadin due to a heart rhythm disturbance, such as atrial fibrillation, or a problem with hypercoagulation. The drug is used to reduce clot formation in the blood.
18) Which of the following is not a sign of unstable angina? A) Chest pain is more frequent or severe. B) Chest pain occurs with less exertion or lasts longer than usual. C) Chest pain does not respond to medications as it did before. D) Chest pain occurs for shorter periods.
Answer: D Explanation: Patients with unstable angina will experience symptoms at rest or with minimal exertion. Symptoms will become less predictable and will remain longer and become less responsive to medications.
28) What causes STEMI? A) An area of ischemia in the heart tissue B) Incomplete occlusion of a coronary artery C) Severe dysrhythmia D) Complete occlusion of a coronary artery
Answer: D Explanation: STEMI occurs as a result of a complete occlusion of a coronary artery.
3) Which of the following is one of the primary branches of the left coronary artery and supplies blood to both of the ventricles? A) Circumflex artery B) Posterior descending artery C) Marginal artery D) Left anterior descending artery
Answer: D Explanation: The left anterior descending artery is one of the primary branches of the left coronary artery; it supplies blood to both ventricles.
25) Which of the following are not common cardiac symptoms in elderly patients? A) Shortness of breath and nausea B) Profuse sweating and pain in the arms C) Syncope and weakness or fatigue D) Hypertension and edema
Answer: D Explanation: The most common cardiac symptoms in elderly patients include shortness of breath, nausea, profuse sweating, pain in the arms, syncope, and weakness or fatigue. Hypertension and edema are not typical cardiac symptoms in the elderly.
10) What is the function of the tunica intima? A) Dilate and constrict to maintain homeostasis B) Keep the vessel open C) Allow medications to pass through D) Come in direct contact with the blood
Answer: D Explanation: The tunica intima comes in direct contact with the blood.
