Patho Exam 2 PrepU Questions

The nurse is teaching a patient with a diagnosis of hypertrophic cardiomyopathy and aortic valve stenosis. Which of the following statements by the patient shows that the patient understands this condition?

"I should report episodes of dizziness or fainting."

A nurse is performing client health education with a 68-year-old man who has recently been diagnosed with heart failure. Which of the following statements demonstrates an accurate understanding of his new diagnosis?

"I'm trying to think of ways that I can cut down the amount of salt that I usually eat."

A patient who will be undergoing a Holter monitor examination would be given which of the following instructions?

"Keep a diary of your activities and symptoms throughout the examination."

Which of the following describes surgical correction of tetralogy of Fallot?

Closure of the ventricular-septal defect and relief of the right ventricular outflow obstruction

The nursing instructor is teaching her nursing students about cardiac function and different heart diseases. Which of the following disease does she tell the students is caused by calcified scar tissue that develops between the visceral and parietal layers of the serous pericardium?

Constrictive pericarditis

A client has been admitted after being resuscitated from a cardiac arrest. The client is stated to be in Class I for electrocardiogram monitoring. What type of monitoring will the nurse perform for this client?

Continuous cardiac monitoring

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:

Continuous measurement of urine output

When an acute MI occurs, many physiologic changes occur very rapidly. What causes the loss of contractile function of the heart within seconds of the onset of an MI?

Conversion from aerobic to anaerobic metabolism

The nurse knows that hypertension can lead to nephrosclerotic damage. Which of the following occurs first in nephrosclerosis?

Glomerular hypoperfusion

A patient has developed atherosclerosis. The nurse knows that a major cause for this disorder is which of the following?

Hypertension

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?

Infective endocarditis

A nurse is monitoring the electrocardiogram (ECG) of a patient with a recent right ventricular infarction. The ECG reveals a first-degree arterioventricular (AV) block, which is characterized by which of the following?

PR interval >0.20 seconds

A monitored hospitalized patient with a pulmonary embolism has been in atrial fibrillation (AF) for 4 days. The nurse observes the rhythm spontaneously convert to a normal sinus rhythm. Which of the following forms of AF is this?

Paroxysmal

A client is at high risk for the development of rheumatic heart disease. The most important information for the nurse to provide would be:

Prompt diagnosis and treatment of streptococcal infection

The pathophysiology of heart failure involves an interaction between decreased pumping ability and the ________ to maintain cardiac output.

compensatory mechanisms

The health care provider has determined that a client diagnosed with cardiogenic shock will now require treatment with the intra-aortic balloon pump. The expected effect of the treatment is:

decreased afterload

Angina pectoris is a chronic ischemic CAD that is characterized by a symptomatic paroxysmal chest pain or pressure sensation associated with transient myocardial ischemia. What precipitates an attack of angina pectoris?

emotional stress

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

Class III

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

"Avoid bearing down while having a bowel movement."

The professor knows that the pathophysiology student understands the structure and function of blood vessels when the student states which of the following?

"Capillaries permit the exchange of material between the blood and interstitial fluid." Correct

What is the most important factor in myocardial oxygen demand?

Heart rate

Which of the following health problems is associated with heart failure as a result of diastolic dysfunction?

Myocardial Hypertrophy

Which serum biomarker is highly specific for myocardial tissue?

Troponin

Anaphylactic shock is directly associated with:

type I hypersensitivity response

The diagnosis is left-sided heart failure. The nurse knows that the most common causes of left-sided failure include which of the following? Select all that apply.

• Hypertension • Acute myocardial infarction

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?

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

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

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

A client awaiting a heart transplant is experiencing decompensation of her left ventricle that will not respond to medications. The physicians suggest placing the client on a ventricular assist device (VAD). The client asks what this equipment will do. The health care providers respond:

"This device will decrease the workload of the myocardium while maintaining cardiac output and systemic arterial pressure."

An elderly client newly diagnosed with systolic hypertension asks her health care provider why this happens. The most accurate response would be:

"With age, your arteries lose their elasticity and are replaced with collagen, which makes your arteries stiffer."

Which of the following classifications of antiarrhythmic drugs act by inhibiting the potassium current and repolarization, thereby extending the action potential and refractoriness?

Class III

A client who came to the emergency room and was diagnosed with ST-segment elevation myocardial infarction (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?

1 hour

Place the events in the renin-angiotensin-aldosterone system in the correct order.

1. Angiotensinogen in plasma 2. Renin release 3. Angiotensin converting enzyme 4. Angiotensin-II production 5. Aldosterone release

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.

1. Antihypertensives 2. Psychotropics 3. Diuretics

A patient with persistent primary hypertension is unhappy with the adverse effects of his current antihypertensive regimen. The nurse will tell the patient that there are several types of antihypertensive drugs having different mechanisms of action and different adverse effect profiles. The physician can vary regimens until an acceptable one is found. Which of the following are antihypertensive medications which the physician might select to use? Select all that apply.

1. Direct acting vasodilators 2. Alpha adrenergic blockers 3. Centrally acting adrenergic agonists

A nurse is planning a community education program on lifestyle modification to manage hypertension. Which of the following topics should be included in the teaching plan? Select all that apply.

1. Limit alcohol consumption 2. Stop smoking 3. Consume a diet rich in fruit, vegetable, and low-fat dairy products. 4. Reduce dietary sodium intake

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?

140/90

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:

20 mL/hour

During an acute MI, there is ischemic damage to the heart muscle. The location and extent of the ischemic damage is the major predictor of complications, ranging from cardiac insufficiency to death, following an MI. What is the "window of opportunity" in restoring blood flow to the affected area so as to diminish the ischemic damage to the heart and maintain the viability of the cells?

20 to 40 minutes

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?

20mL/hr

The nurse knows that mean arterial pressure is determined as which of the following?

60% of diastolic pressure and 40% of systolic pressure

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:

64 mm Hg

Which of the following patients is at greatest risk for orthostatic hypotension?

A 66-year-old post-surgery patient on bed rest

The physician understands that which of the following clients is at risk for developing primary hyperlipoproteinemia?

A client with familial hypercholesterolemia

Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell?

A hypercyanotic attack brought on by periods of stress

A client arrives at the emergency room with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 and blood pressure of 86/50. The cardiac monitors show regular rhythm as above. The client states his physician has been running blood work to rule out hypothyroidism. Based on the rhythm what does the nurse report the client has?

A symptomatic bradyarrhythmia

Cardiac reserve refers to which of the following events?

Ability to increase cardiac output during physical exercise

ST-elevated myocardial infarction is accompanied by severe, crushing pain. Morphine is the drug of choice used to treat the pain of STEMI when the pain cannot be relieved with oxygen and nitrates. Why is morphine considered the drug of choice in STEMI?

Action decreases metabolic demands of the heart.

A patient with a diagnosis of chronic renal failure secondary to diabetes has seen a gradual increase in her blood pressure over the past several months, culminating in a diagnosis of secondary hypertension. Which of the following has most likely resulted in the patient's increased blood pressure?

Activation of the renin-angiotensin-aldosterone mechanism

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

Administer epinephrine (adrenaline).

A client has been diagnosed with atrial flutter. What assessment finding does the nurse expect?

An atrial heart rate above 240 beats per minute

A nurse is caring for four patients. Which of the following patients is most at risk for atrial fibrillation (AF)?

An elderly male who is 2 days postcoronary artery bypass surgery

Which of the following patients should most likely be assessed for orthostatic hypotension?

An elderly patient who has experienced two falls since admission while attempting to ambulate to the bathroom

The client is diagnosed with a respiratory sinus arrhythmia. What will the nurse assess?

An increase in heart rate with inspiration and slowing with expiration.

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.

Anaphylatic shock

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

Anaphylaxic

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

Angiotensin-converting enzyme (ACE) inhibitors

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

Antibiotics and anti-inflammatory drugs

The nurse recognizes that there are many factors that influence blood flow within the systemic circulation. In the circulatory system, which of the following are called resistance vessels?

Arterioles

Paroxysmal supraventricular tachycardia arises from which of the following forms of reentry?

Arterioventricular (AV) nodal

A client with a history of acute coronary syndrome asks why she needs to take aspirin 81 mg every day. The most appropriate response by the nurse would be:

Aspirin will help prevent blood clotting

A nurse is caring for a patient with persistent atrial fibrillation. Which of the following interventions is the priority?

Assessing for shortness of breath or changes in level of consciousness

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

Atherosclerosis and unstable angina

Dysrhythmias can occur in patients with heart failure. The dysrhythmia that occurs most frequently in heart failure is which of the following?

Atrial fibrillation

The purpose of a cardioversion device is the treatment of which of the following cardiac disorders?

Atrial fibrillation

A nurse is teaching a patient newly prescribed with an angiotensin-converting (ACE) inhibitor. Which of the following is important information to include in the teaching plan?

Avoid salt substitutes and foods high in potassium.

A client who was diagnosed with hypertension is now taking a medication that decreases heart rate and cardiac output. The nurse determines that the medication is a:

Beta adrenergic blocker

Which of the following antidysrhythmic medications works by blunting the effect of sympathetic nervous system stimulation on the heart?

Beta blockers, such as metoprolol

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

Beta-adrenergic blockers

In pregnancy, which of the following data are diagnostic for pre-eclampsia and eclampsia?

Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy

A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.

Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy.

The nurse 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?

Blood pressure in arms 20 mm Hg higher than in the legs

Persistent cyanosis has led an infant's care team to suspect a congenital heart defect. Which of the following assessment findings would suggest coarctation of the infant's aorta?

Blood pressure in the child's legs is lower than in the arms

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

Bradycardia with rate of 20-40

A client's primary care provider has added 20 mg of Lasix (furosemide) to his medication regimen to treat his primary hypertension. How does this agent achieve its therapeutic effect?

By decreasing vascular volume by increasing sodium and water excretion

A client who has been admitted to the ICU with a diagnosis of pericardial effusion begins to experience severe tachycardia. Upon assessment the nurse finds that his central venous pressure is increased, he has jugular vein distention, his systolic blood pressure has dropped, and there is a narrow pulse pressure. His heart sounds appear to be very muffled. Which diagnosis should the nurse suspect the physician will make?

Cardiac Tamponade

A nurse is planning a community education program on hypertension. Which of the following parameters should be included to explain the regulation of arterial blood pressure?

Cardiac output and systemic vascular resistence

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?

Cardiogenic

The nurse is caring for a patient who has been admitted to the hospital with a diagnosis of unstable angina and the client wants to know why daily ECGs are necessary. The nurse explains that the ECGs can pick up early indications of cardiac ischemia and the nurse knows that according to the American Heart Association practice standards, the client falls into which of the following ECG monitoring categories?

Class I

In aortic regurgitation, failure of aortic valve closure during diastole causes an abnormal drop in diastolic pressure. This change in pressure causes decreased:

Coronary Perfusion

A client with a past medical history of congestive heart failure is admitted to the hospital with severe palpitations and a heart rate of 170, blood pressure 88/60. Home medications include Digoxin, a loop diuretic, and a baby aspirin. The physician has diagnosed the client with focal atrial tachycardia and is discussing the treatment options with the client. Which of the following actions would most likely be ordered first?

Correction of the underlying cause

The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be:

Decreased cardiac output

The nurse knows that in heart failure, the increase in renal secretion of renin is caused by which of the following?

Decreased cardiac output

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?

Decreased level of concsiousness

From which one of the following sites is a fatal pulmonary thromboembolism most likely to originate?

Deep vein thrombophlebitis of the leg

A patient's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The patient is unconscious and without a pulse. Which of the following priority interventions should the nurse take?

Defibrillate the patient

Select the statement that best describes Buerger disease.

Disease of young, heavy cigarette smokers occurring before the age of 35. Correct

For which of the following types of shock might intravenous antibiotic therapy be indicated?

Distributive shock

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 matches which of the following drug categories to the action of decreasing vascular volume by suppressing renal reabsorption of sodium and increasing salt and water excretion?

Diuretics

The nurse knows that which group of antihypertensive drugs is usually the least expensive and is well tolerated?

Diuretics

Heart failure in an infant usually manifests itself as tachypnea or dyspnea, both at rest and on exertion. When does this most commonly occur with an infant?

During feeding

Brugada syndrome, an autosomal dominant disorder, manifests in adulthood as ST-segment elevation, right bundle branch block, and susceptibility to ventricular tachycardia. In Brugada syndrome, the timing of cardiac events is significant. When do these cardiac events typically occur?

During sleep or rest

A nurse in a nursing home is concerned that a resident may be developing left heart failure. Manifestations of left heart failure would include which of the following symptoms?

Dyspnea, cough

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

Echocardiogram

What is the primary physiologic result of obstructive shock?

Elevated right heart pressure

A client has been diagnosed with diabetes mellitus. Which of the following lab results would the practitioner expect?

Elevation of triglycerides

The client undergoes a cardiac catheterization to evaluate symptoms of chest pain and shortness of breath. The test shows lesions in the coronary arteries that have begun to reduce the size of the vessel lumen. This type of lesion is known as which of the following?

Fibrous atheromatous plaque

Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart.

Fills rapidly; compresses

Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by:

Fixed coronary obstruction

Pregnancy-induced hypertension is a serious condition affecting between 5% and 10% of pregnant women. The most serious classification of hypertension in pregnancy is preeclampsia-eclampsia. It is a pregnancy-specific syndrome that can have both maternal and fetal manifestations. What is a life-threatening manifestation of the preeclampsia-eclampsia classification of pregnancy-induced hypertension?

HELLP Syndrome

Nearly everyone with pericarditis has chest pain. With acute pericarditis, the pain is abrupt in onset, sharp, and radiates to the neck, back, abdomen, or sides. What can be done to ease the pain of acute pericarditis?

Have the client sit up and lean forward

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?

Headache and confusion

Anaphylactic shock causes severe hypoxia very quickly because of which of the following reasons?

Histamine release causes massive vasodilation.

The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:

History of cigarette smoking and elevated blood pressure

Football fans at a college have been shocked to learn of the sudden death of a star player, an event that was attributed in the media to "an enlarged heart." Which of the following disorders was the player's most likely cause of death?

Hypertrophic cardiomyopathy (HCM)

Increased cardiac workload with left heart failure can result in which of the following change to the myocardial cells?

Hypertrophy

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

Hypotension

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?

Hypovolemic

A client has just returned from his surgical procedure. During initial vital sign measurements, the nurse notes that the client's heart rate is 111 beats/minute and the BP is 100/78 (borderline low). In this early postoperative period, the nurse should be diligently monitoring the client for the development of:

Hypovolemic shock due to acute intravascular volume loss

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

Immediate defibrillation

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

Immune-mediated inflammation

The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:

Improving quality of life by relieving symptoms

Which of the following statements regarding heart failure is true?

In compensated heart failure an increase of end-diastolic volume causes increased force of left ventricular contraction.

When will the nurse plan to assess a patient's blood pressure to confirm the possible diagnosis of orthostatic hypotension?

In the morning before arising from bed

An 86-year-old male client is disappointed to learn that he has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which of the following age-related changes predisposes older adults to developing heart failure?

Increased vascular stiffness

Disease of the arterial system affects body function by impairing blood flow. Which of the following terms refers to an area of necrosis in an organ produced by occlusion of its arterial blood supply?

Infarction

A patient has developed left heart failure. Which of the following symptoms might have precipitated this condition?

Myocardial Infarction

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

Inherent spontaneous action-potential

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?

Inhibition of the conversion of angiotensin I to angiotensin II, decreasing angiotensin II levels and reducing its effect on vasoconstriction

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

Intrathoracic pressure changes that occur with respiration

Which of the following is the site of chylomicron synthesis?

Small Intestine

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?

Intravenous

While studying the heart the nursing instructor teaches about pericarditis. Which of the following does she tell the student best defines this disease?

It is an inflammatory process

A patient is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which of the following actions is important for the nurse to tell the patient to ensure accuracy in correlating dysrhythmias with symptoms?

It is important to keep a diary of activities and symptoms.

The pediatrician is examining a young client and notes necrotizing damage to the coronary arteries in the child's echocardiogram. The pediatrician suspects the child has which of the following?

Kawasaki disease

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?

Laryngeal edema

The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states that blood is shunted from the:

Left side of the heart to the right side of the heart

A patient is diagnosed with systolic hypertension. The nurse knows that this patient is at risk for which of the following?

Left ventricular hypertrophy

The nurse administers nitroglycerin to a patient with acute coronary syndrome. Which of the following is the best explanation of the expected outcome?

Limiting the size of the infarction

A 30-year-old male brought to the emergency department has the following admission data: Blood pressure 50/30, pulse 100, respiratory rate 12, temperature 101°F. The nurse does not know the exact cause but does know that patient is in shock because of which of the following readings?

Low Blood Pressure

Increased secretion of renin in heart failure is caused by which of the following events?

Low cardiac output

The nurse's brother is not convinced that he should quit smoking. He asks his sister (the nurse) to demonstrate for him the more immediate effects of smoking on his health. Which of the following could be used to help convince the brother to stop smoking?

Measure his blood pressure and show him how much higher it is when he is smoking.

A nurse notes that the PR interval on a patient's electrocardiogram tracing is 0.22 seconds. Which of the following actions should the nurse take?

Monitor the patient and document the findings.

The nurse working in the emergency room triages a client who comes in with complaints of chest pain, shortness of breath, sweating and elevated anxiety. The physician suspects a myodardial infarction. The client is given a nitrate, which does nothing for his pain. Which of the following medications should the nurse suspect the doctor will order next for the pain?

Morphine

ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?

Most ECG-detected ischemic events are clinically silent.

The nurse is caring for a 75-year-old client with end-stage emphysema who is having severe dyspnea. The nurse is evaluating the client's cardiac rhythms and notes a very irregular rhythm with P waves before most if not all the QRS complexes with a rate of 140. With closer inspection of the cardiac rhythm the nurse notes the P waves all look different. Which of the following most accurately describes this rhythm?

Multifocal atrial tachycardia

A client arrives at the doctor's office complaining of severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate which of the following?

Myocardial infarction

The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client.

Myocardial infarction prevention

Suddenly a client in the surgical intensive care unit develops ventricular fibrillation following open heart surgery. What does the nurse immediately prepares for?

Nonsynchronized defibrillation

A client who developed a deep vein thrombosis during a prolonged period of bed rest has deteriorated as the clot has dislodged and resulted in a pulmonary embolism. Which of the following types of shock is this client at risk of experiencing?

Obstructive Shock

A client with a long history of stable angina suddenly experiences substernal pain that radiates to the left arm, neck, and jaw. He describes the pain as severe and feels as if he is suffocating. He has taken nitroglycerin and not experienced any relief. The client is most likely experiencing:

Onset of STEMI

A patient with supraventricular tachycardia has received a dose of verapamil to slow the heart rate. Which of the following describes the effect of this drug on the heart?

P wave above the baseline

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

Paroxysmal supraventricular tachycardia

The nurse is caring for a group of patients from 7 am to 7 pm. Which patient should be seen first as the nurse starts the shift?

Patient with new onset unstable angina who is scheduled for a cardiac catheterization at 2 pm

Exudate in the pericardial cavity is a characteristic of which cardiac condition?

Pericardial effusion

A client is seen in the emergency room with complaints of sharp chest pain that started abruptly. He says it has radiated to his neck and abdomen. He also states that it is worse when he takes a deep breath or swallows. He tells the nurse that when he sits up and leans forward the pain is better. Upon examination the nurse notes a pericardial friction rub and some EKG changes. Which disease should the nurse suspect this client to have?

Pericarditis

A client was in car accident client while not wearing a seatbelt and has sustained multiple rib fractures. During assessment, the nurse is having a hard time hearing heart sounds, and the client reports chest pain/pressure repeatedly. This client may be experiencing:

Pericarditis perfusion

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?

Peripheral edema weight gain

The nurse caring for a patient 12 hours post coronary bypass graft notes a sudden decrease in the amount of chest tube drainage, a rapidly narrowing pulse pressure, paradoxical pulse, and shortened amplitude of the QRS complex on the electrocardiogram monitor. Which of the following should the nurse do next?

Prepare for pericardiocentesis

A patient experiencing a sinus arrest would demonstrate which of the following symptoms or findings?

Prolonged periods of asystole demonstrated on an electrocardiogram

The nurse knows that vasopressin (antidiuretic hormone, ADH) plays which role in blood pressure control?

Promotes retention of water

A preventative measure to decrease the risk of developing rheumatic heart disease includes which of the following?

Prompt diagnosis of streptococcal infections with a throat culture

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:

Pulmonary Embolism

Cardiac tamponade is a serious life-threatening condition that can arise from a number of other conditions. What is a key diagnostic finding in cardiac tamponade?

Pulsus paradoxus

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.

Race and family History

A nurse preceptor is evaluating the skills of a new registered nurse (RN) caring for clients experiencing shock. Which action by the new RN indicates a need for more education?

Raising the head of the bed to a high Fowler's position

The nurse knows that the basic pathophysiology of heart failure is best described as which of the following?

Reduced ventricular efficiency

An intensive care unit nurse is caring for a 50-year-old client who was admitted 8 hours before, following an anterior wall myocardial infarction (MI). The nurse notes frequent premature ventricular complexes on the client's ECG monitor and is concerned that the client could develop a lethal arrhythmia if one of the premature ventricular complexes fires just after which of the following?

Relative refractory period ends

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?

Release nitric oxide

A patient is prescribed an angiotensin converting enzyme inhibitor (ACEI) for hypertension. The nurse knows that ACEIs are contraindicated by which clinical condition?

Renal artery stenosis

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?

Right-sided heart failure

Which of the following is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?

SA node -> AV node -> bundle of His -> bundle branches -> Purkinje fibers

A 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?

Sclerotherapy or surgery

A client who is experiencing angina at rest that has been increasing in intensity should be instructed to do which of the following?

See the Doctor for evaluation immediately

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?

Septic

An emergency room nurse is caring for a client with cardiomyopathy who has chest pain and shortness of breath. Vital signs include: heart rate 100, blood pressure 84/62, RR 30 and temp 37.0. Cardiac monitor reveals an irregular rhythm with frequent premature ventricular complexes. The nurse understands that this client is at risk for which of the following?

Serious arrhythmias

A nurse witnesses an elderly woman sitting outside who suddenly faints and is helped to the ground by family. She is awake, although confused, heart rate 130, RR 28. The woman states that all of a sudden she felt dizzy, but denies other symptoms. She says that her husband died last week and she has been very upset. The nurse determines that which of the following is the most likely reason for the syncopal episode?

Severe anxiety

An important factor in the mortality of severe shock is acute renal failure. What impacts the extent of renal damage in shock?

Severity and duration of shock

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

Sinus tachycardia

A nurse is teaching a patient with postural hypotension about effective ways to increase cardiac output while sitting and standing. Which of the following ways should be included?

Slight leg movement during standing and crossing the legs when sitting

A patient with supraventricular tachycardia has received a dose of verapamil to slow the heart rate. Which of the following describes the effect of this drug on the heart?

Slows the sinoatrial (SA) node pacemaker and inhibit conduction in the atrioventricular (AV) node

Venous thrombosis most commonly occurs in the lower extremities. Risk factors for venous thrombosis include which of the following?

Stasis of blood, hypercoagulability, vessel wall injury

A nurse is administering medication to treat hypercholesterolemia. Which of the following medications reduces or blocks the hepatic synthesis of cholesterol?

Statins

What is the primary cause of heart failure in infants and children?

Structural (congenital) heart defects are the most common cause of heart failure in children.

A patient is diagnosed with stage 2 hypertension. The nurse knows that which of the following is characteristic of stage 2 hypertension?

Sustained systolic pressure equal to or greater than 160 mm Hg

The smooth muscle cells produce vasoconstriction of blood vessels due to innervation by which part of the nervous system?

Sympathetic

A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of which of the following?

Sympathetic Nervous System

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?

Systemic vasoconstriction maintained the diastolic pressure.

A 70-year-old client with a past medical history of diabetes type II and myocardial infarction (MI) is admitted to the hospital with sudden shortness of breath and palpitations. As the nurse is doing the admission assessment she notices that the apical pulse is very irregular with no pattern, vital signs include a heart rate of 130 and blood pressure of 100/60. The nurse suspects atrial fibrillation (AF) for which of the following reasons? Select all that apply.

Tachycardia Irregular-irregular rhythm Palpitations

Which of the following patients is at the greatest risk of developing rheumatic heart disease?

Teenager with unrelated strep throat

A client reporting a headache is diagnosed with giant cell arteritis. The nurse is aware that the vessels most commonly affected are the:

Temporal

Torsade de pointes is a specific type of polymorphic ventricular tachycardia in which the polarity of the QRS complex swings between positive and negative, often on a beat-to-beat basis. It is the result of the long QT syndrome and can cause sudden cardiac death. Which medication is not linked to torsade de pointes as a causative agent?

Tetracycline

When lecturing to a group of students about the pathophysiological principles behind heart failure, the instructor explains that cardiac output represents:

The amount of blood the heart pumps each minute

In second-degree atrioventricular block, there is a relationship between the P waves and the QRS complex resulting in recurring PR intervals. What does this mean?

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

Which client will the nurse prioritize to assess first?

The client with sinus arrest

The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as:

The condition is getting progressively worse.

The nurse knows that the primary long term regulation of blood pressure is exerted by which of the following?

The kidneys

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?

The most common cause of staph infection

The nurse is caring for a client who develops atrial fibrillation. What concern is the highest priority for this client?

The risk of emboli

A client has been diagnosed with aortic stenosis and asks the nurse what this means. The most appropriate response would be:

The valve opening is narrowed and produces increased resistance to blood flow out of the left ventricle and into the aorta.

Heart failure and circulatory shock are both conditions of circulatory system failure. Which of the following statements regarding these conditions is correct?

They have the same compensatory mechanisms.

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

Third-degree AV block

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

Transcutaneous

A client with a 2-week history of hyperthyroidism due to a virus is admitted for non-emergent cardioversion. The client states that she has been experiencing intermittent episodes of palpitations over the past week along with shortness of breath and fatigue. The nurse attaches the client to a cardiac monitor and notes that the client is in normal sinus rhythm with frequent episodes of atrial fibrillation. The nurse anticipates which of the following to be ordered prior to the cardioversion to avoid a possible stroke?

Transesophageal echocardiography

A client comes to the emergency room with all the symptoms of a myodardial infarction. Which lab value does the nurse suspect the physician will order which is known to have a high specificity for myocardial tissue and has become the primary biomarker test for diagnosing an MI?

Troponin Assays

A client with a suspected MI is brought to the emergency department by ambulance. The nurse caring for this client would expect to receive an order for which laboratory test to confirm a diagnosis of MI?

Troponin level

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?

Unknown

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?

Valvular Regurgitation

A client who is relatively healthy is seen in the clinic for a regular checkup. While there he tells the nurse that he is worried that he may develop a heart condition. When the nurse asks him why he is worried he tells her that his mother had aortic valve stenosis and is afraid that he might get it. He then asks to be tested for the disease. What should the nurse tell this patient about diagnosing a valvular defect?

Valvular defects usually are detected through cardiac auscultation.

An elderly client asks the nurse why so many older people develop heart failure. The best response would be increased:

Vascular stiffness

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins?

Vasoconstriction

A person with blood pressure of 68/38 fainted after donating a unit of blood. The blood bank technician stated that the person was experiencing low preload from loss of blood volume. The nurse knows that preload refers to which of the following?

Venous return to the heart

A male patient with a history of angina has presented to the emergency department with uncharacteristic chest pain. His subsequent electrocardiogram (ECG) reveals T-wave elevation. This finding suggests an abnormality with which of the following aspects of the cardiac cycle?

Ventricular repolarization

The nursing student has learned in class that pericarditis is an inflammatory process of the pericardium. Which of the following is known to be the main cause of pericarditis?

Viral infection

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

Weighing every day at the same time with same type of clothing

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?

Will prevent the conversion of angiotensin I to angiotensin II

A client with new onset atrial fibrillation (AF) is being admitted to the hospital for possible cardioversion. The initial vital signs include a heart rate of 160 and blood pressure of 90/60. The admission nurse anticipates the presence of a pulse deficit. To verify this finding which of the following would the nurse do?

With another nurse assess the apical and radial pulses simultaneously for one minute.

The most common causes of left-sided heart failure include:

acute myocardial infarction

The nurse is preparing to auscultate for a mitral valve stenosis murmur Where is the best location to place the stethoscope?

at the apex of the heart

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

blood culture

Which of the following is the greatest diagnostic limitation of an electrocardiogram (ECG)?

it documents only current cardiac function

An 80-year-old male client arrives for his yearly physical without any complaints and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:

many people live with atrial fibrillation without even knowing they have it.

A nurse is assessing a child who has a congenital heart defect for cyanosis. Select the most important area for the nurse to assess.

mucous membrane

A patient has developed cardiogenic shock. The most frequent cause of this type of shock is which of the following?

myocardial infarction

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

p wave

A client comes to the emergency room exhibiting signs and symptoms of right-sided heart failure. Upon X-ray it is determined that he has 250ML of fluid in the pericardial cavity. Which disease should the nurse suspect this client to be suffering?

pericardial effusion

A 62-year-old female client presents to the emergency department and is diagnosed with acute heart failure syndrome. Assessment data would include:

productive cough with frothy sputum.

An intensive care unit nurse is caring for a client who suffered a myocardial infarction involving the anterior wall, and notes a change in the cardiac rhythm. The rhythm has a PR interval that does not change, but there are twice as many P waves as there are R waves. The nurse prepares for a temporary pacemaker insertion because the client has developed:

second-degree, type 2 AV block.

A college student is in pre-op area prior to knee surgery. The nurse attaches the cardiac monitor and notes a gradual lengthening and shortening between the R waves. The nurse realizes that this rhythm is most often found in people with healthy hearts. This rhythm is a respiratory:

sinus arrythmia

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

sinus bradycardia

In hypovolemic shock, the main purpose of treatment is correcting or controlling the underlying cause of the hypovolemia and improving the perfusion of the tissues and organs of the body. Which of the following treatments is not a primary form of therapy for hypovolemic shock?

vasoconstrictive drugs

Severe shock can be followed by acute lung injury/acute respiratory distress syndrome (ALI/ARDS) characterized by:

ventilation-perfusion mismatch.

Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment?

ventricular fibrillation

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?

weight gain

From the following clients, who are at high risk for developing heart failure as a result of diastolic dysfunction? Select all that apply.

• A 48-year-old client with uncontrolled hypertension • A 70-year-old with enlarged left ventricle due to myocardial hypertrophy

Two months following a myocardial infarction (MI) a client visits the physician because of severe fatigue and shortness of breath. During the evaluation the client reports frequent episodes of palpitations over the past couple of weeks that cause the shortness of breath to increase. A 12-lead ECG reveals that the client has atrial fibrillation with a heart rate of 120. The practitioner should consider which of the following medications? Select all that apply.

• Antiarrhythmics • Anticoagulants

Changes in systemic blood pressure are a reflection of which of the following properties of the cardiovascular system? Select all that apply.

• Aortic elasticity • Stroke volume • Resistance in arterioles

A client presents with sinus tachycardia. What is an appropriate nursing action? Select all that apply.

• Assess the client's temperature • Assess the client's pain level • Assess the client's vital signs

Autonomic nervous system control of blood pressure is mediated through which of the following? Select all that apply.

• Baroreceptors in blood vessels • Carotid artery chemoreceptors • Pain and strong emotion • Aortic chemoreceptors

The nursing student correctly identifies which of the following as major risk factors for coronary artery disease? Select all that apply.

• Cigarette smoking • Elevated LDL • Diabetes • Abdominal obesity

A child brought to the emergency department is suspected to have heart failure. The nurse knows that which statements regarding heart failure in children are true? Select all that apply.

• Congenital defects are a risk factor. • Symptoms include tachypnea and tachycardia. • Inotropic agents such as digoxin may be used in children.

A patient has developed secondary hypertension. The nurse knows that causes of secondary hypertension include which of the following? Select all that apply.

• Cushing's syndrome • Oral contraceptives • Aortic coarctation • Pheochromocytoma

A patient exhibits signs and symptoms of heart failure, including fatigue and shortness of breath. Which of the following tests are suggested to support a diagnosis of heart failure? Select all that apply.

• Electrocardiogram (EKG) • Cardiac computed tomography (CCT) • Echocardiography • Chest x-ray

At the cellular level, cardiac muscle cells respond to an increase in ventricular volume to the point of overload by: Select all that apply.

• Elongating the cardiac muscle cells • Decreasing the ventricular wall thickness

The nurse will monitor which of the following respiratory manifestations of heart failure? Select all that apply.

• Exertional dyspnea • Orthopnea • Cheyne-Stokes respiration • Chronic dry cough

A client with a past medical history of idiopathic cardiomyopathy is admitted to the hospital for the placement of an automatic implantable cardioverter defibrillator (AICD) due to frequent episodes of non-sustained ventricular fibrillation (V-tach). When the admitting nurse attaches the cardiac monitor the presenting rhythm is V-tach. The nurse identifies which of the following in the rhythm? Select all that apply.

• Heart rate of 80 • Monomorphic QRS complexes • QRS complexes > 0.12 seconds

A client with a history of Wolff-Parkinson White (WPW) syndrome is admitted for symptomatic tacharrhythmias resistant to medications. The client is asking what causes these episodes to occur. The nurse responds that the most common reason for the tachycardia is the development of reentry circuits which can be caused by which of the following? Select all that apply.

• Hyperkalemia • Myocardial ischemia • Myocardial infarction

Which of the following statements regarding hypertension are correct? Select all that apply.

• Hypertension is a major risk factor for cardiovascular disease. • Hypertension is one of the most common health problems for adults. • Hypertension is more frequent among younger men than in younger women.

A child brought to the emergency department is suspected to have heart failure. The nurse knows that which statements regarding heart failure in children are true? Select all that apply.

• Inotropic agents such as digoxin may be used in children. • Congenital defects are a risk factor. • Symptoms include tachypnea and tachycardia.

The nurse knows that which of the following would put a patient at risk of developing hypertension, if everything else in the body remained unchanged? Select all that apply.

• Intravascular fluid retention • Elevated renin levels • Systemic vasoconstriction

The nurse is teaching a group of clients about hypertension. The nurse determines that teaching was effective when the clients state: Select all that apply.

• It is the most common cardiovascular disorder. • The incidence increases with age. • The systolic pressure is greater than or equal to 140 mm Hg

When an acute event occurs and the circulatory system can no longer provide the body with adequate perfusion of its tissues and organs, cellular hypoxia occurs and the body goes into shock. What are the causes of shock in the human body? (Select all that apply.)

• Maldistribution of blood flow • Hypovolemia • Obstruction of blood flow

The nurse should suggest which of the following medications for a patient in cardiogenic shock? Select all that apply.

• Nitroprusside (Nitropress) • Nitroglycerin • Dobutamine (Dobutrex) • Milrinone (Primacor)

After a long bout with vomiting and diarrhea, a patient is suspected to be in hypovolemic shock. Which of the following signs and symptoms will the nurse evaluate to substantiate this diagnosis? Select all that apply.

• Tachycardia • Acidosis • Apprehension

The sympathetic (adrenergic) nervous system is an important compensatory mechanism in heart failure. Which of the following statements regarding the sympathetic nervous system response to heart failure are correct? Select all that apply.

• The sympathetic nervous system responds rapidly to a fall in cardiac output. • The sympathetic nervous system increase in heart rate and force of contraction support cardiac output. • The sympathetic nervous system increase in cardiac workload and oxygen use can cause ischemia and worsening of heart failure.

Cardiac output is which of the following per minute? Select all that apply.

• Volume of blood pumped • Heart rate X stroke volume