Pathophysiology II: Exam 1

A nurse recalls the most common cardiac valve disease in the United States is: a. mitral valve prolapse. b. pulmonary stenosis. c. tricuspid valve prolapse. d. aortic stenosis.

ANS: A Mitral valve prolapse is the most common valve disorder in the United States. Neither pulmonary stenosis, tricuspid valve prolapse, nor aortic stenosis is the most common valve disorder in the United States.

Monocytes are blood cells that mature (differentiate) into: a. macrophages. b. neutrophils. c. eosinophils. d. mast cells.

ANS: A Monocytes mature into macrophages, not neutrophils, eosinophils, or mast cells.

Cardiac cells can withstand ischemic conditions for _____ minutes before irreversible cell injury occurs.

ANS: 20 Cardiac cells can withstand ischemic conditions for about 20 minutes before irreversible hypoxic injury causes cellular death (apoptosis) and tissue necrosis.

A function of the pericardium is to: a. provide a barrier against extracardial infections. b. improve blood flow through the heart. c. play a role in cardiac conduction. d. assist in cardiac contraction.

ANS: A A function of the pericardium is to provide a barrier against extracardial infections. The pericardium does not improve blood flow through the heart as it is on the outside. The inner portions of the heart control cardiac conduction. The muscular layers assist with cardiac contraction.

What term is used to identify the period that follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated? a. Absolute refractory b. Hyperpolarization c. Resting d. Threshold

ANS: A A refractory period is the time during which no new cardiac action potential can be initiated by a stimulus. It follows depolarization. Neither hyperpolarization nor resting correctly identifies this period. Threshold is related to depolarization.

Within a normal physiologic range, an increase in left ventricular end-diastolic volume would lead the nurse to monitor for: a. an increased force of contraction. b. a decrease in cardiac output. c. an increase in heart rate. d. heart failure.

ANS: A An increase in end-diastolic volume leads to an increased force of contraction because fibers are stretched to handle increased volume. Cardiac output would increase. Although volume increases, heart rate does not respond accordingly. An increase in end-diastolic volume would not lead to heart failure since failure results in output decrease.

The greatest proportion of total body iron is located in the: a. erythrocytes. b. spleen pulp. c. bone marrow. d. liver tissue.

ANS: A Approximately 67% of total body iron is bound to heme in erythrocytes (hemoglobin) and muscle cells (myoglobin).

One difference between cardiac muscle and skeletal muscle is that: a. cardiac muscle cells are arranged in branching networks. b. skeletal muscle cells have only one nucleus. c. cardiac muscle cells appear striped. d. skeletal muscle cells contain sarcomeres.

ANS: A Cardiac cells are arranged in branching networks throughout the myocardium, whereas skeletal muscle cells tend to be arranged in parallel units throughout the length of the muscle. Cardiac muscle cells have only one nucleus, whereas skeletal muscle cells have many nuclei. Both cardiac and muscle cells appear striped and contain sarcomeres.

During an infection, lymph nodes enlarge and become tender because: a. lymphocytes are rapidly dividing. b. edema accumulates within the fibrous capsule. c. microorganisms are accumulating. d. the nodes are not functioning properly.

ANS: A During an infection, the rate of proliferation of lymphocytes within the nodes is so great that the nodes enlarge and become tender. Edema may be present, but the tenderness is due to proliferation of lymphocytes and is a normal function of the nodes. The tenderness is not due to the microorganisms.

A 30-year-old female presents to her primary care provider with fever, cardiac murmur, and petechial skin lesions and is diagnosed with infective endocarditis. The most likely cause of the disease is: a. bacteria. b. viruses. c. fungi. d. parasites.

ANS: A Infective endocarditis is due to a bacterial infection, not a viral, fungal, or parasitic infection.

Which characteristic changes should the nurse keep in mind while caring for a patient with left heart failure? As left heart failure progresses: a. left ventricular preload increases. b. systemic vascular resistance decreases. c. left end-diastolic volume decreases. d. pulmonary vascular resistance decreases.

ANS: A Left ventricular preload increases in left heart failure because less blood is ejected from the left ventricle. Left heart failure does not lead to a decrease in systemic resistance; it leads to an increase in resistance. Left end-diastolic volume will increase. Pulmonary vascular resistance will increase.

Which of the following assessment findings is most likely to occur following a splenectomy? a. Leukocytosis b. Hypoglycemia c. Decreased red blood cell count d. Decreased platelets

ANS: A Leukocytosis often occurs after splenectomy. A splenectomy is not a trigger for hypoglycemia or decreased levels of either red blood cells or platelets.

Most cases of combined systolic and diastolic hypertension have no known cause and are documented on the chart as _____ hypertension. a. primary b. secondary c. congenital d. acquired

ANS: A Most cases of hypertension are diagnosed as primary hypertension, not secondary, which is due to a known cause. Most cases of hypertension are not a result of congenital or acquired causes.

A 56 year old presents to his primary care provider for a checkup. Physical exam reveals edema, hepatomegaly, and muffled heart sounds. Which of the following is of greatest concern to the nurse? a. Tamponade b. Exudate c. Aneurysm d. Pulsus paradoxus

ANS: A Muffled heart sounds are an indication of tamponade, and with tamponade the blood backs up into the venous system, leading to hepatomegaly. Muffled heart sounds with hepatomegaly are symptoms of tamponade, not exudates. An aneurysm would present without symptoms. Pulsus paradoxus is manifested by a change in blood pressure during inspiration and expiration.

An adult patient's blood sample is analyzed in a laboratory. Assuming a normal sample, which type of white blood cell accounts for the highest percentage? a. Neutrophil b. Eosinophil c. Basophil d. Lymphocyte

ANS: A Neutrophils constitute about 65-75 of the total leukocyte count in adults. The eosinophils, which have large, coarse granules, constitute only 2%-5% of the normal leukocyte count in adults. Basophils make up less than 1% of the leukocytes. Lymphocytes constitute approximately 36% of the total leukocyte count.

A nurse is discussing the pressure generated at the end of diastole. Which term is the nurse describing? a. Preload b. Afterload c. Systemic vascular resistance d. Total peripheral resistance

ANS: A Preload, not afterload, is the volume and associated pressure generated in the ventricle at the end of diastole. Afterload is the resistance to ejection of blood from the left ventricle. Systemic vascular resistance is related to afterload. Total peripheral resistance increases afterload.

A 72-year-old female has a history of right heart failure caused by a right ventricular myocardial infarction. Which of the following symptoms are specifically related to her right heart failure? a. Significant edema to both lower legs and feet b. Hypertension c. Decreased urine output d. Dyspnea upon exertion

ANS: A Right-sided failure allows blood to back up into the systemic circulation, leading to peripheral edema. Since it is backed up into the venous system, hypertension is less likely. Right-sided failure leads to edema and a greater venous blood volume, which would lead to increased urinary output. Dyspnea upon exertion is more indicating of left-sided failure.

A 65-year-old male is diagnosed with chronic pulmonary disease and elevated pulmonary vascular resistance. Which of the following heart failures should the nurse assess for in this patient? a. Right heart b. Left heart c. Low-output d. High-output

ANS: A Right-sided failure occurs when the patient experiences chronic pulmonary disease and elevated pulmonary vascular resistance because the blood has difficulty overcoming the pressure and blood builds up in the right side of the heart. Pulmonary congestion leads to right-sided failure, not left, low-output failure, and high-output failure.

Which cytokines participate in hematopoiesis? a. Stimulating factors (CSFs) b. Eosinophils c. Basophils d. Neutrophils

ANS: A Several cytokines participate in hematopoiesis, particularly CSFs (or hematopoietic growth factors). Neither eosinophils, basophils, nor neutrophils play a role in hematopoiesis.

A 28 year old presents to the ER reporting severe chest pain that worsens with respirations or lying down. Other signs include a fever, tachycardia, and a friction rub. Assessment findings support which medical diagnosis? a. Acute pericarditis b. Myocardial infarction (MI) c. Stable angina d. Pericardial effusion

ANS: A Severe chest pain that worsens with respirations or lying down in a patient with fever, tachycardia, and a friction rub is characteristic of acute pericarditis. MI pain does not worsen with respirations. Stable angina does not worsen with respiration or lying down. Pericardial effusion is not manifested by these symptoms.

A 45-year-old male is diagnosed with sideroblastic anemia. When he asks what the most likely cause of this disease is, what is the nurse's best response? a. Ineffective iron uptake and abnormal hemoglobin production b. Misshapen erythrocytes with low hemoglobin c. Decreased levels of tissue iron with megaloblastic erythrocytes d. Premature erythrocyte destruction and erythropoietin deficiency

ANS: A Sideroblastic anemia is due to ineffective iron uptake and hemoglobin production. Erythrocytes are neither misshapen, premature, nor destroyed in sideroblastic anemia. Sideroblastic anemia is not associated with decreased levels of tissue iron with megaloblastic erthrocytes.

A 51-year-old male is at the health clinic for an annual physical exam. After walking from the car to the clinic, he developed substernal pain. He also reported discomfort in his left shoulder and his jaw, lasting 2-3 minutes and then subsiding with rest. He indicates that this has occurred frequently over the past few months with similar exertion. The nurse suspects he is most likely experiencing: a. stable angina. b. unstable angina. c. Prinzmetal angina. d. myocardial infarction (MI).

ANS: A Stable angina is associated with activity and subsides with rest. Unstable angina is a form of acute coronary syndrome that results from reversible myocardial ischemia and occurs at rest. Chest pain that occurs at rest and at night is descriptive of Prinzmetal angina. MI pain does not subside with rest.

What is the nurse monitoring when observing the QRS complex on the electrocardiogram? a. Ventricular activity b. Pulmonary artery closure c. Mitral valve opening d. Aortic valve closing

ANS: A The QRS complex represents the sum of all ventricular muscle cell depolarizations, not the closure of the pulmonary artery. The QRS complex does not reflect activity of either the mitral or aortic valves.

Which structures act as anchors for the atrioventricular valves? a. Chordae tendineae b. Great vessels c. Coronary ostia d. Trabeculae carneae

ANS: A The atrioventricular valve openings are attached to the papillary muscles by the chordae tendineae. The great vessels are the vessels that bring blood to and out of the heart and are not attached to the chordae tendineae. The coronary ostia are openings in the aorta for the coronary arteries. The trabeculae carneae are a portion of the myocardium.

Blood flow is affected by: (Select all that apply.) a. blood viscosity. b. blood vessel diameter. c. blood pressure. d. blood vessel length. e. blood composition.

ANS: A, B, C, D Resistance to flow is generally greater in longer tubes because resistance increases with length but decreases with a wider diameter. Blood flow varies inversely with the viscosity of the fluid. Thick fluids move more slowly and experience greater resistance to flow than thin fluids. Increased blood pressure decreases blood flow because resistance is increased. Blood volume, not composition, plays a role in blood flow.

A nurse is evaluating stroke volume. Which of the following factors affect stroke volume? (Select all that apply.) a. Preload b. Peripheral vascular resistance c. Afterload d. Ejection fraction e. Contractility

ANS: A, C, E Preload, afterload, and contractility affect stroke volume.

While checking lab results, the nurse remembers that the normal leukocyte count is: a. 1000-2000 per cubic millimeter. b. 5000-10,000 per cubic millimeter. c. 4.2-6.2 million per cubic millimeter. d. 1.2-2.2 million per cubic millimeter.

ANS: B 5000-10,000 per cubic millimeter is the normal leukocyte count. 1000-2000 per cubic millimeter is an abnormally low leukocyte count. 4.2-6.2 million per cubic millimeter is the normal erythrocyte count. 1.2-2.2 million per cubic millimeter would indicate anemia.

A patient who demonstrates chronic gastrointestinal bleeding is diagnosed with anemia. What is the primary cause of the patient's anemia? a. Vitamin B12 deficiency b. Iron deficiency c. Folate deficiency d. Bone marrow failure

ANS: B A continuous loss of blood is one of the most common causes of iron deficiency anemia (IDA). Gastrointestinal bleeding does not lead to vitamin B12 deficiency, folate deficiency, or bone marrow failure.

A newborn is diagnosed with congenital intrinsic factor deficiency. Which of the following types of anemia will the nurse see documented on the chart? a. Iron deficiency b. Pernicious c. Sideroblastic d. Hemolytic

ANS: B A lack of the intrinsic factor leads to pernicious anemia. Iron deficiency anemia is not related to the intrinsic factor. Pernicious anemia is due to the lack of the intrinsic factor; sideroblastic anemia is not related to the intrinsic factor. Hemolytic anemia results from destruction of cells.

A 51-year-old male presents with recurrent chest pain on exertion and is diagnosed with angina pectoris. The pain occurs when: a. cardiac output has fallen below normal levels. b. the myocardial oxygen supply has fallen below demand. c. myocardial stretch has exceeded the upper limits. d. the vagus nerve is stimulated.

ANS: B Angina is chest pain caused by myocardial ischemia, which develops if the flow or oxygen content of coronary blood is insufficient to meet the metabolic demands of myocardial cells. A decrease in cardiac output would lead to general systemic symptoms, not just chest pain, which is due to a decrease in myocardial oxygenation. Myocardial stretch does not affect angina symptoms. When the vagus nerve is stimulated, a change in rate occurs; it does not precipitate chest pain.

A 67 year old was previously diagnosed with rheumatic heart disease. Tests now reveal lipoprotein deposition with chronic inflammation that impairs blood flow from the left ventricle into the aorta. Which diagnosis does this history support? a. Aortic regurgitation b. Aortic stenosis c. Mitral regurgitation d. Mitral stenosis

ANS: B Aortic stenosis would impair blood flow from the left ventricle to the aorta. Aortic regurgitation would allow blood to flow back into the left ventricle. Mitral regurgitation would allow blood to flow from the left ventricle to the left atrium. Mitral stenosis would impair blood flow from the left atrium to the left ventricle.

When a patient is diagnosed with coronary artery disease, the nurse assesses for myocardial: a. hypertrophy. b. ischemia. c. necrosis. d. inflammation.

ANS: B Coronary artery disease leads to myocardial ischemia. Coronary artery disease would not lead to hypertrophy but not to ischemia, necrosis, or inflammation.

Depolarization of a cardiac muscle cell occurs as the result of: a. a decrease in the permeability of the cell membrane to ions. b. the rapid movement of ions across the cell membrane. c. a blockade by calcium ions. d. stimuli instigated during the refractory period.

ANS: B Depolarization is caused by the movement of electrically charged solutes (ions) across cardiac cell membranes. Permeability must be increased for movement to occur. A blockage of calcium ions would decrease depolarization. No cardiac action potential can be initiated in the refractory period.

A 40-year-old male's history includes being a vegetarian and abusing alcohol. Which of the following factors put him at greatest risk for developing folate deficiency anemia? a. Being vegetarian b. Being alcoholic c. Age d. Gender

ANS: B Folate deficiency occurs more often in alcoholics and individuals who are malnourished because of fad diets or diets low in vegetables. Being alcoholic promotes the greatest risk, since this disorder is diet related. A diet high in vegetables would help prevent folate deficiency. Age is not a factor in folate deficiency. Gender is not a factor in folate deficiency.

A 5 year old was diagnosed with normocytic-normochromic anemia. Which type of anemia does the nurse suspect the patient has? a. Sideroblastic b. Hemolytic c. Pernicious d. Iron deficiency

ANS: B Hemolytic anemia is an example of normocytic-normochromic anemia. Sideroblastic anemia is an example of microcytic hypochromic anemia. Pernicious anemia is an example of a macrocytic anemia. Iron deficiency anemia is an example of microcytic hypochromic anemia.

When a nurse is reviewing lab results and notices that the erythrocytes contain an abnormally low concentration of hemoglobin, the nurse calls these erythrocytes: a. hyperchromic. b. hypochromic. c. macrocytic. d. microcytic.

ANS: B Hypochromic erythrocytes have low concentrations of hemoglobin. Hyperchromic erythrocytes have high concentrations of hemoglobin. Macrocytic and microcytic refer to cell size.

A 42 year old is diagnosed with constrictive pericarditis. The nurse assesses the blood pressure for decreased cardiac output because of: a. pericardial effusions. b. fibrosis and calcification of the pericardial layers. c. cardiomyopathy. d. hemorrhage in the pericardial cavity.

ANS: B In constrictive pericarditis, fibrous scarring compresses the heart and eventually reduces cardiac output. Pericardial effusion is manifested by chest pain. Cardiomyopathy is a general term for pathophysiologic changes in the heart. Hemorrhage in the pericardial cavity will lead to tamponade.

A 49-year-old male presents reporting chest pain. EKG reveals ST elevation. He is diagnosed with myocardial ischemia. Which of the following interventions would be most beneficial? a. Administer a diuretic to decrease volume. b. Apply oxygen to increase myocardial oxygen supply. c. Encourage exercise to increase heart rate. d. Give an antibiotic to decrease infection.

ANS: B Increasing the myocardial oxygen supply is indicated to treat ischemia. A decrease in fluid volume is not appropriate. Heart rate should be decreased to decrease cardiac workload. Antibiotics are not the most beneficial; oxygen is.

A 21-year-old female was recently diagnosed with iron deficiency anemia. In addition to fatigue and weakness, which of the following clinical signs and symptoms would she most likely exhibit? a. Hyperactivity b. Spoon-shaped nails c. Gait problems d. Petechiae

ANS: B Iron deficiency anemia is manifested by fingernails that become brittle and spoon shaped or concave. It does not involve hyperactivity, gait problems, or petechiae.

A patient was admitted to the intensive care unit with a diagnosis of acute myocardial infarction (MI) and is being treated for shock. The primary cause of shock is most likely: a. rapid heart rate. b. decreased cardiac contractility. c. increased capillary permeability. d. decreased afterload due to vasodilation.

ANS: B MI leads to decreased cardiac contractility due to a damaged myocardium and would lead to shock. A rapid heart rate would not cause shock. Increased capillary permeability would not lead to shock. Decreased afterload will not lead to shock associated with MI.

A nurse takes an adult patient's blood pressure and determines it to be normal. What reading did the nurse obtain? a. Systolic pressure between 140 and 150 mm Hg b. Systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg c. Systolic pressure less than 100 mm Hg regardless of diastolic pressure d. Systolic pressure greater than 140 mm Hg and a diastolic pressure of 100 mm Hg

ANS: B Normal blood pressure has a systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg. A systolic pressure of 140 mm Hg or more would indicate stage I hypertension. A systolic pressure of less than 100 mm Hg would indicate low blood pressure. A diastolic pressure greater than 90 mm Hg would indicate hypertension.

A 58-year-old female presents in the clinic with fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit, a high mean corpuscular volume, and normal plasma iron. These assessment findings are consistent with which type of anemia? a. Hemolytic anemia b. Pernicious anemia c. Iron deficiency anemia d. Aplastic anemia

ANS: B Pernicious anemia is manifested by tingling paresthesias of feet and fingers. The symptomology is not associated with hemolytic, iron deficiency, or aplastic anemias.

In addition to playing a role in hemostasis, platelets have the ability to: a. stimulate bone marrow production of erythrocytes. b. release biochemical mediators of inflammation. c. undergo cell division in response to bleeding. d. activate a humoral response.

ANS: B Platelets contain cytoplasmic granules capable of releasing proinflammatory biochemical mediators when stimulated by injury to a blood vessel. Platelets assist with inflammation; they do not produce erythrocytes, undergo cell division in response to bleeding, or activate the humoral response.

A 73 year old has increased pulmonary pressure resulting in right heart failure. A potential cause for the right heart to fail is: a. hypertension. b. left heart failure. c. acute pneumonia. d. pericarditis.

ANS: B Right-sided failure often follows left-sided failure when pulmonary congestion forces backward flow of blood into the left ventricle. It is not due to hypertension, pneumonia, or pericarditis.

As stated by the Frank-Starling law, there is a direct relationship between the _____ of the blood in the heart at the end of diastole and the _____ of contraction during the next systole. a. pressure; duration b. volume; force c. viscosity; force d. viscosity; duration

ANS: B The Frank-Starling law of the heart describes the length-tension relationship of ventricular end-diastolic volume (VEDV) (preload) to myocardial contractility (as measured by stroke volume). It does not refer to duration, pressure, or viscosity.

What represents the sum of all ventricular muscle cell depolarization? a. PR interval b. QRS complex c. QT interval d. P wave

ANS: B The QRS complex represents the sum of all ventricular muscle cell depolarizations. The PR interval represents the onset of atrial activation to the onset of ventricular activity. The QT interval represents "electrical systole" of the ventricles. The P wave represents atrial depolarization.

A 50-year old received trauma to the chest that caused severe impairment of the primary pacemaker cells of the heart. Which of the following areas received the greatest damage? a. Atrioventricular (AV) node b. Sinoatrial (SA) node c. Bundle of His d. Ventricles

ANS: B The SA node, not the AV node, is considered the pacemaker of the heart. Neither the bundle of His nor the ventricles are involved.

What structure conducts action potentials down the atrioventricular septum? a. Bachmann bundle b. Bundle of His c. Sinoatrial node d. Atrioventricular node

ANS: B The bundle of His conducts action potentials down the atrioventricular septum, not the Bachmann bundle. The sinoatrial node conducts the potential along the atria while the atrioventricular node conducts impulses to the ventricles.

A 75-year-old male has severe chest pain and dials 911. Based upon the lab findings indicating a patient has elevated levels of cardiac troponins I and T, the nurse suspects which of the following has occurred? a. Raynaud disease b. Myocardial infarction (MI) c. Orthostatic hypotension d. Angina

ANS: B The diagnosis of acute MI is made on the basis of serial cardiac biomarker alterations. The cardiac troponins (troponins I and T) are the most specific indicators of MI. Elevated troponins I and T are indicative of MI, not Raynaud disease, orthostatic hypotension, or angina.

A 20 year old underwent an echocardiogram to assess chest pain. Results revealed a congenital defect in the papillary muscles. Which of the following would the nurse expect to occur? a. Closure of the semilunar valve b. Backward expulsion of the atrioventricular valves c. Closure of the atrioventricular valve d. Backward expulsion of the semilunar valves

ANS: B The papillary muscles are extensions of the myocardium that pull the cusps together and downward at the onset of ventricular contraction, thus preventing their backward expulsion into the atria. Defects in the papillary muscles would not affect either the semilunar or atrioventricular valves.

A 75-year-old obese female presents to her primary care provider reporting edema in the lower extremities. Physical exam reveals that she has varicose veins. Upon performing the history, which of the following is a possible cause for the varicose veins? a. Extreme exercise b. Long periods of standing c. Trauma to the deep veins d. Ischemia

ANS: B The probable cause of the patient's varicose veins is gradual venous distention caused by the action of gravity on blood in the legs due to long periods of standing. Varicose veins are most likely due to long periods of standing leading to the action of gravity promoting venous distention. Exercise would help prevent this. Trauma can occur, but usually this affects the more superficial veins. Ischemia affects arteries, not veins.

A 60-year-old patient diagnosed with emphysema experiences a rapid and pounding heart, dizziness, and fatigue with exertion. Which respiratory assessment findings indicate the respiratory system is compensating for the increased oxygen demand? a. Bronchoconstriction b. Increased rate and depth of breathing c. Dyspnea d. Activation of the renin-angiotensin response

ANS: B The rate and depth of breathing increase in an effort to increase oxygen availability accompanied by an increase in the release of oxygen from hemoglobin. Bronchodilation occurs, not constriction. Dyspnea is not a compensatory mechanism but a side effect of the body's attempt to increase oxygen. The respiratory system does not activate the renin-angiotensin response; the kidneys are involved.

A 35 year old presents with pulmonary hypertension and is diagnosed as being in right heart failure. Which is the most likely cause of this condition? a. Aortic stenosis b. Tricuspid regurgitation c. Aortic regurgitation d. Mitral regurgitation

ANS: B Tricuspid regurgitation leads to volume overload in the right atrium and ventricle, increased systemic venous blood pressure, and right heart failure. Aortic stenosis is manifested by narrowed pulse pressure. Aortic regurgitation is manifested by widened pulse pressure resulting from increased stroke volume and diastolic backflow. Mitral regurgitation is manifested by heart failure but not pulmonary hypertension.

A 68-year-old male presents to the ER reporting chest pain. He has a history of stable angina that now appears to be unstable. He most likely has: a. mild to moderate atherosclerosis. b. impending myocardial infarction (MI). c. electrical conduction problems in the heart. d. decreased myocardial oxygen demand.

ANS: B Unstable angina is an indication of impending MI. Unstable angina could be caused by moderate atherosclerosis, altered electrical conduction, or a decrease in myocardial oxygen, but it is an indication of impending MI.

A 65-year-old male with a history of untreated hypertension is now experiencing left heart failure. A nurse recalls his untreated hypertension led to: a. ventricular dilation and wall thinning. b. myocardial hypertrophy and ventricular remodeling. c. inhibition of renin and aldosterone. d. alterations in alpha and beta receptor function.

ANS: B With hypertension comes increased afterload and resistance to ventricular emptying and more workload for the ventricle, which responds with hypertrophy of the myocardium and ventricular remodeling. Ventricular dilation can occur, but the wall will thicken, not thin. Renin and aldosterone release are increased, not inhibited. Alterations in alpha and beta functioning may occur, but the response to hypertension is myocardial hypertrophy and ventricular remodeling.

A 72 year old has a history of hypertension and atherosclerosis. An echocardiogram reveals backflow of blood into the left ventricle. Which of the following is the most likely diagnosis documented on the chart? a. Mitral regurgitation b. Mitral stenosis c. Aortic regurgitation d. Aortic stenosis

ANS: C Aortic regurgitation would allow backward flow of blood into the left ventricle. Mitral regurgitation would allow backward flow of blood into the left atrium. Mitral stenosis would impede blood flow from the right atrium into the right ventricle. Aortic stenosis would impede blood flow into the aorta.

A patient presents to a primary care provider reporting chest pain and is diagnosed with atherosclerosis. This disease is caused by: a. arterial wall thinning and weakening. b. abnormally dilated arteries and veins. c. abnormal thickening and hardening of vessel walls. d. autonomic nervous system imbalances.

ANS: C Atherosclerosis is a form of arteriosclerosis characterized by thickening and hardening of the vessel wall. Affected arteries are narrowed, not dilated. Atherosclerosis is not related to autonomic nervous system imbalances, which would lead to changes in rate or rhythm.

Baroreceptors are located in the: a. renal artery. b. superior vena cava. c. carotid artery. d. circle of Willis.

ANS: C Baroreceptors are found in the carotid arteries. They are not found in the renal artery, the superior vena cava, or the circle of Willis.

A nurse observes a cardiologist multiplying the heart rate by stroke volume. What is the cardiologist measuring? a. Vascular resistance b. Preload c. Cardiac output d. Ejection fraction

ANS: C Cardiac output is found by the heart rate times stroke volume. Vascular resistance is not a factor in the calculation of cardiac output; it does play a role in blood pressure. Preload affects cardiac output but is not the result of heart rate times stroke volume. Ejection fraction is the amount ejected per beat

An older adult is diagnosed with cerebral aneurysm. Where does the nurse suspect the cerebral aneurysm is located? a. Vertebral arteries b. Basilar artery c. Circle of Willis d. Carotid arteries

ANS: C Cerebral aneurysms often occur in the circle of Willis. Such an aneurysm is not associated with the vertebral arteries, the basilar artery, or the carotid arteries.

A 62-year-old male presents to his primary care provider reporting chest pain at rest and with exertion. He does not have a history of coronary artery disease and reports that the pain often occurs at night. He is most likely experiencing which type of angina? a. Unstable b. Stable c. Prinzmetal d. Silent

ANS: C Chest pain that occurs at rest and at night is descriptive of Prinzmetal angina. Unstable angina is a form of acute coronary syndrome that results from reversible myocardial ischemia. Stable angina is predictable and occurs with activity. Silent angina has few, if any, symptoms.

While reviewing lab results, the nurse recalls that the most abundant cells in the blood are: a. leukocytes. b. lymphocytes. c. erythrocytes. d. thrombocytes.

ANS: C Erythrocytes (red blood cells) are the most abundant cells of the blood, occupying approximately 48% of the blood in men, and 42% in women.

Erythropoietin is produced in the: a. liver. b. bone marrow. c. kidneys. d. spleen.

ANS: C Erythropoietin is produced in the kidneys, not the liver, bone marrow, or spleen.

Inflammatory cells have difficulty limiting the colonization of microorganisms in infective endocarditis because the: a. microorganisms are resistant. b. valves are avascular. c. microorganisms are sequestered in a fibrin clot. d. colonies overwhelm the phagocytes.

ANS: C In endocarditis, bacterial colonies are inaccessible to host defenses because they are embedded in the protective fibrin clots; it is not because the microorganisms are resistant, that the valves are avascular, or that the colonies overwhelm the phagocytes.

The nurse will check which of the following tests to directly measure iron stores? a. Serum ferritin b. Transferrin saturation c. Bone marrow biopsy d. Total iron-binding capacity

ANS: C Iron stores are measured directly by bone marrow biopsy, not serum ferritin, transferrin saturation, and total iron-binding capacity.

The nurse realizes the patient diagnosed with mitral stenosis has incomplete emptying of the: a. right atrium. b. right ventricle. c. left atrium. d. left ventricle.

ANS: C Mitral stenosis would result in incomplete emptying of the left atrium, as the mitral valve is located between the left atrium and left ventricle.

Fibrinolysis is mediated by: a. heparin. b. fibrinogen. c. plasmin. d. albumin.

ANS: C Plasmin is an enzyme that promotes fibrinolysis by degrading fibrin and fibrinogen into fibrin degradation products. Neither heparin, fibrinogen, nor albumin plays this role in the process of fibrinolysis.

A patient's anemia is described as having erythrocytes that demonstrate poikilocytosis. The nurse would recognize the erythrocytes would be: a. pale in color. b. present in various sizes. c. able to assume various shapes. d. live only a few days.

ANS: C Poikilocytosis means the erythrocytes are able to assume various shapes; it does not refer to color, size, and life span.

After birth, red blood cells are normally made only in the: a. liver. b. spleen. c. bone marrow. d. kidney.

ANS: C Red blood cells are produced in the bone marrow, not the liver, spleen, or kidney.

A 13 year old took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect? a. Decreased myocardial contraction b. Decreased heart rate c. Increased cardiac conduction d. Increased intranodal conduction time

ANS: C Stimulation of the SA node by the sympathetic nervous system rapidly increases cardiac conduction. Stimulation of the sympathetic nervous system would increase myocardial contraction and heart rate. Such simulation would not affect conduction time within the node. These are inherent rates.

The PR interval viewed on a normal electrocardiogram represents: a. atrial depolarization. b. ventricular depolarization. c. onset of atrial activation to onset of ventricular activity. d. "electrical systole" of the ventricles.

ANS: C The PR interval represents the onset of atrial activation to the onset of ventricular activity. The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The QT interval represents "electrical systole" of the ventricles.

A 55-year-old male died of a myocardial infarction. Autopsy would most likely reveal: a. embolization of plaque from the aorta. b. decreased ventricular diastolic filling time. c. platelet aggregation within the atherosclerotic coronary artery. d. smooth muscle dysplasia in the coronary artery.

ANS: C The autopsy would reveal platelet aggregation within an atherosclerotic coronary artery. The cause of death is most likely occlusion of the coronary artery, not emboli from the aorta, decreased filling time, or dysplasia in the artery.

A patient with left heart failure starts to have a cough and dyspnea. Pulmonary symptoms common to left heart failure are a result of: a. inflammatory pulmonary edema. b. decreased cardiac output. c. pulmonary vascular congestion. d. bronchoconstriction.

ANS: C The clinical manifestations of left heart failure are the result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation. Pulmonary edema does occur, but it is not due to inflammation. Decreased cardiac output does occur, but the pulmonary symptoms are related to pulmonary congestion. Pulmonary symptoms are not due to bronchoconstriction.

Which chamber of the heart generates the highest pressure? a. Right atrium b. Left atrium c. Left ventricle d. Right ventricle

ANS: C The left ventricle generates the highest pressure of all the heart's chambers.

The most common cause of myocardial ischemia is: a. idiopathic vasospasm. b. arterial emboli from a heart valve. c. atherosclerosis. d. venous emboli.

ANS: C The most common cause of myocardial ischemia is atherosclerosis. Myocardial ischemia is not caused by idiopathic vasospams or venous emboli. Arterial emboli may cause ischemia, but atherosclerosis is the major cause of myocardial ischemia.

The pericardium is: a. the outer muscular layer of the heart. b. the innermost layer of the heart chambers. c. a membranous sac that encloses the heart. d. the heart's fibrous skeleton.

ANS: C The pericardium is the membranous sac that surrounds the heart. The outer layer that acts as the fibrous skeleton of the heart is the myocardium. The innermost layer of the heart is the endocardium.

A 35-year-old female is diagnosed with vitamin B12 deficiency anemia (pernicious anemia). The most likely cause is a decrease in: a. ferritin. b. gastric enzymes. c. intrinsic factor. d. erythropoietin.

ANS: C The underlying alteration in pernicious anemia (PA) is the absence of intrinsic factor (IF), an enzyme required for gastric absorption of dietary vitamin B12, a vitamin essential for nuclear maturation, and DNA synthesis in red blood cells. PA is not due to a decrease in ferritin, gastric enzymes, or erythropoietin but to a lack of intrinsic factor.

The molecule that aids in bonding of the troponin complex to actin and tropomyosin is troponin: a. C. b. I. c. T. d. M.

ANS: C Troponin T aids in the binding of the troponin complex to actin and tropomyosin. Troponin C contains binding sites for the calcium ions involved in contraction. Troponin I inhibits the ATPase of actomyosin. Troponin M is not a substance.

Many valvular stenosis and regurgitation disorders in adults have a common etiology. Which of the following conditions should alert the nurse that the patient may have both types of valve dysfunctions? a. Heart failure b. Connective tissue disorders c. Rheumatic fever or heart disease d. Syphilis infection

ANS: C Valvular dysfunction is often related to rheumatic fever. Heart failure decreases cardiac output but does not affect valvular function. It is not due to connective tissue disorders. Syphilis infection could affect valves, but it is not the most common cause.

Which valvular condition is characterized by the valve opening being constricted and narrowed, causing the valve leaflets, or cusps, to fail to open completely? a. Regurgitation b. Insufficiency c. Stenosis d. Incompetence

ANS: C Valvular stenosis occurs when the valve opening is constricted and narrowed. Valvular regurgitation occurs when blood moves backward into the chamber from which it came. Valvular insufficiency occurs when blood regurgitates backward into the chamber from which it came. Valvular incompetence leads to regurgitation.

A 65 year old experienced loss of appetite, weight loss, lemon-yellow skin, liver enlargement, and a beefy red tongue shortly before her death. Autopsy suggested pernicious anemia, and the cause of death would most likely reveal: a. brain hypoxia. b. liver hypoxia. c. heart failure. d. kidney failure.

ANS: C When the hemoglobin has decreased to 7-8 grams per deciliter, the individual experiences the classic symptoms of anemia: weakness, fatigue, paresthesias of feet and fingers, difficulty walking, loss of appetite, abdominal pain, weight loss, and a sore tongue that is smooth and beefy red. The skin may become lemon yellow (sallow), which is caused by a combination of pallor and jaundice. Hepatomegaly, indicating right-sided heart failure, may be present in the elderly. The symptoms are not associated with brain or liver hypoxia, or kidney failure.

Which individual should the nurse assess initially for a vitamin B12 deficiency anemia? a. A 3-year-old female who is a fussy eater b. A 26-year-old female in the second trimester of her first pregnancy c. A 47-year-old male who had a gastrectomy procedure d. A 64-year-old male with a history of duodenal ulcers

ANS: C With removal of the stomach, the intrinsic factor is also removed, leading to an inability to absorb B12; thus, the person with removal of the stomach is at greatest risk. Being a fussy eater, being pregnant, and having a history of duodenal ulcers are not risk factors for vitamin B12 deficiency anemia.

A nurse assesses the heart after acetylcholine because the effect of acetylcholine on the heart is to: a. decrease the refractory period. b. increase calcium influx. c. increase the strength of myocardial contraction. d. decrease the heart rate.

ANS: D Acetylcholine causes decreased heart rate and slows conduction through the AV node; it does not decrease the refractory period nor does it increase calcium influx. It does not increase the strength of myocardial contraction.

After initial compensation, what hemodynamic change should the nurse monitor for in a patient who has a reduction in the number of circulating erythrocytes? a. Increased viscosity of blood b. Decreased cardiac output c. Altered coagulation d. Hyperdynamic circulatory state

ANS: D After initial compensation, the blood flows faster and more turbulently than normal blood, causing a hyperdynamic circulatory state. Blood viscosity decreases rather than increases. Cardiac output increases. Alteration in coagulation does not occur.

Which type of white blood cell contains preformed granules of vasoactive amines? a. Neutrophil b. Eosinophil c. Monocyte d. Basophil

ANS: D Basophils have cytoplasmic granules that contain vasoactive amines (e.g., histamine) and an anticoagulant (heparin). Their function is similar to tissue mast cells. Neutrophils are the chief phagocytes of early inflammation. Eosinophils ingest antigen-antibody complexes and are induced by IgE-mediated hypersensitivity reactions to attack parasites. Monocytes do not have amines, and their job is to help fight infection.

As a result of blockage in the pulmonary artery, blood would first back up into the: a. aorta. b. left ventricle. c. pulmonary veins. d. right ventricle.

ANS: D Blockage in the pulmonary artery would cause blood to back up into the right ventricle, not the aorta since these two vessels do not communicate. The pulmonary artery and left ventricle do not communicate. Blockage in the pulmonary artery would not cause blood to back up into the pulmonary vein since the pulmonary vein takes blood to the left atrium.

Which electrolyte will the nurse check to ensure normal platelet functioning? a. Sodium b. Potassium c. Magnesium d. Calcium

ANS: D Calcium is necessary for many of the intracellular signaling mechanisms that control platelet activation. Control of platelet activation is not associated with sodium, potassium, or magnesium.

The cardiac electrical impulse normally begins spontaneously in the sinoatrial (SA) node because it: a. has a superior location in the right atrium. b. is the only area of the heart capable of spontaneous depolarization. c. has rich sympathetic innervation via the vagus nerve. d. depolarizes more rapidly than other automatic cells of the heart.

ANS: D Cardiac impulses occur in the SA node because its cells depolarize more rapidly than other automatic cells, not because of its superior location. The SA node is not the only area of the heart capable of spontaneous depolarization. The SA node does have rich innervations but by parasympathetic innervation from the vagus nerve.

A patient is diagnosed with coronary artery disease. Which of the following modifiable risk factors would the nurse suggest the patient change? a. Eating meat b. Living arrangements c. Drinking tomato juice d. Smoking cigarettes

ANS: D Cigarette smoking leads to vasoconstriction and should be the first behavior the patient changes. Eating meat alone would not lead to the development of coronary artery disease. The living arrangement of the patient's home would not lead to the development of coronary artery disease. Drinking tomato juice would not lead to the development of coronary artery disease.

A group of cells isolated in the laboratory have membrane-bound granules in their cytoplasm, and they show phagocytic activity. Which of the following cells is most similar? a. Monocyte b. Macrophage c. Lymphocyte d. Eosinophil

ANS: D Eosinophils, which have large, coarse granules, are capable of ameboid movement and phagocytosis. Monocytes help fight infection. Macrophages are mature monocytes. Lymphocytes are the primary cells of the immune response.

A nurse is caring for a patient who cannot clot. Which end product of the clotting cascade is this patient unable to make? a. Collagen b. Fibrinogen c. Thrombin d. Fibrin

ANS: D Fibrin is the end product of the coagulation cascade. While involved in the coagulation cascade, neither collagen, fibrinogen, nor thrombin is considered the end product of the coagulation cascade.

While planning care for a newborn, the pediatric nurse recalls that the site of hematopoiesis in the fetus is the: a. bone marrow. b. kidney. c. lymph nodes. d. spleen.

ANS: D Hematopoiesis is constantly ongoing, occurring in the liver and spleen of the fetus and only in bone marrow (medullary hematopoiesis) after birth. Fetal hematopoiesis does not occur in the bone marrow, kidney, or lymph nodes.

The predominant phagocyte of early inflammation is the: a. eosinophil. b. lymphocyte. c. macrophage. d. neutrophil.

ANS: D Neutrophils are the chief phagocytes of early inflammation. Eosinophils ingest antigen-antibody complexes and are induced by IgE-mediated hypersensitivity reactions to attack parasites. Most lymphocytes transiently circulate in the blood and eventually reside in lymphoid tissues as mature T cells, B cells, or plasma cells. Macrophages migrate out of the vessels in response to infection or inflammation but are not the early responders.

The internal lining of the cardiovascular system is formed by what tissue? a. Tunica adventitia b. Connective c. Mesothelium d. Endothelium

ANS: D The endothelium, not the tunica adventitia, is the lining of blood vessels. Connective tissues help make up arterial walls but are not the lining of blood vessels. The mesothelium is a part of the pericardial cavity.

Which structures would not receive an electrical impulse when the patient is experiencing a left bundle branch block? a. Atrioventricular (AV) node b. Sinoatrial (SA) node c. Bundle of His d. The left ventricle

ANS: D The left bundle branch conducts impulses to the left ventricle; the AV node feeds conduction of the bundles. The SA node initiates conduction while the bundle of His precedes the division of the left and right bundles.

Which statement indicates the nurse understands coronary ostia? The coronary ostia (the openings to the coronary arteries) are found in the: a. left ventricle. b. inferior vena cava. c. coronary sinus. d. aorta.

ANS: D The ostia are found on the aorta, not the ventricle, the vena cava, or the coronary sinus.

A 60-year-old female has survived a myocardial infarction. The nurse is providing care for impaired ventricular function because: a. there is a temporary alteration in electrolyte balance. b. there is too much stress on the heart. c. the cells become hypertrophic. d. the resulting ischemia leads to hypoxic injury and myocardial cell death.

ANS: D The patient has impaired ventricular functioning because a portion of the myocardium has died due to ischemia. Impaired ventricular function is due to damage to the myocardium; it is not due to electrolyte imbalance. There was stress on the heart, but the impaired functioning is due to myocardial damage secondary to ischemia. The impaired ventricular dysfunction is due to myocardial cell death, not hypertrophy.

A 28 year old with seizure disorder has a vagus nerve stimulator implanted to help control seizure activity. Which result will the nurse expect to occur? a. Increased speed of cardiac cycle b. Increased cardiac contractility c. Decreased vasodilation d. Decreased cardiac conduction

ANS: D The vagus nerve releases acetylcholine. Acetylcholine causes decreased heart rate and slows conduction through the AV node, thus decreasing the speed of the cardiac cycle. This reaction also decreases contractility but does not cause decreased vasodilation.

A patient presents to the emergency department reporting difficulty swallowing and shortness of breath. A CT scan would most likely reveal an aneurysm in the: a. cerebral vessels. b. renal arteries. c. inferior vena cava. d. thoracic aorta.

ANS: D Thoracic aortic aneurysms can cause dysphagia (difficulty swallowing) and dyspnea (breathlessness). Aneurysms in cerebral vessels will produce a headache. Aneurysms in the renal arteries will produce flank pain. Aneurysms in the inferior vena cava may produce chest pain.

A 25-year-old female has a heavy menses during which she loses a profuse amount of blood. Which of the following adaptations should the nurse expect? a. Movement of fluid into the cell b. Decreased cardiac output c. Decreased oxygen release from hemoglobin d. Peripheral vasoconstriction

ANS: D When the anemia is severe or acute in onset (e.g., hemorrhage), the initial compensatory mechanism is peripheral blood vessel constriction, diverting blood flow to essential vital organs. Fluid moves into the vascular space, not the cell. Blood volume increases; thus, cardiac output increases. There is an increase in hemoglobin release of oxygen.