Chapter 23: Alterations of Cardiovascular Function My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 23: Alterations of Cardiovascular Function

Test Bank

MULTIPLE CHOICE

1. A 60-year-old male presents to his primary care provider reporting chest pain. He 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.

Atherosclerosis is a form of arteriosclerosis characterized by thickening and hardening of the vessel wall. Arteries are thickened, not thinning.

Atherosclerosis is a form of arteriosclerosis characterized by thickening and hardening of the vessel wall. Arteries are narrowed, not dilated.

Atherosclerosis is a form of arteriosclerosis characterized by thickening and hardening of the vessel wall. It is not related to autonomic nervous system imbalances, which would lead to changes in rate or rhythm.

REF: p. 594

2. A patient wants to know what causes atherosclerosis. How should the nurse respond? In general, atherosclerosis is caused by:

a.

High serum cholesterol levels

b.

Endothelial injury and inflammation

c.

An increase in antithrombotic substances

d.

Congenital heart disease

ANS: B

Atherosclerosis begins with injury to the endothelial cells that line artery walls.

High serum cholesterol levels are associated with atherosclerosis, but are not its cause.

Atherosclerosis begins with injury to the endothelial cells that line artery walls. It is not due to an increase in antithrombotic substances.

Atherosclerosis begins with injury to the endothelial cells that line artery walls. It is not related to congenital heart disease.

REF: p. 594

3. A staff member asks a nurse what foam cells are. What is the nurses best response? Foam cells in a fatty streak are:

a.

Deposited adipose cells

b.

Injured neutrophils

c.

Macrophages that engulf low-density lipoprotein (LDL)

d.

Lipid-laden mast cells

ANS: C

Foam cells are lipid-laden macrophages that engulf LDL.

Foam cells are lipid-laden macrophages that engulf LDL. They are deposited in vessels, not adipose cells.

Foam cells are lipid-laden macrophages that engulf LDL. They are not injured neutrophils.

Foam cells are lipid-laden macrophages that engulf LDL. They are not mast cells.

REF: p. 595

4. A nurse takes an adult patients blood pressure and determines it to be normal. What reading did the nurse obtain?

a.

Systolic pressure between 140 mm Hg 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.

REF: p. 587

5. 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.

Most cases of hypertension are diagnosed as primary hypertension, not secondary, which is due to a known cause.

Most cases of hypertension are diagnosed as primary hypertension, not congenital.

Most cases of hypertension are diagnosed as primary hypertension, not acquired.

REF: p. 587

6. A 30-year-old Caucasian female was recently diagnosed with primary hypertension. She reports that she eats fairly well, usually having red meat and potatoes daily. She also reports that her father has hypertension as well. A nurse determines which of the following risk factors is most likely associated with this diagnosis?

a.

Race

b.

Diet

c.

Age

d.

Genes

ANS: D

Genetic factors, such as family history of hypertension, are the number one factor in the development of hypertension.

Race is a factor, but genetic factors are primary.

Diet is a factor, but genetic factors are primary.

Age is a factor, but not in this case; since the patient is 30, genetics are a greater factor.

REF: p. 587

7. A 65-year-old male presents for a routine checkup. A blood pressure check reveals a systolic pressure of 160 mm Hg and a diastolic pressure of 70 mm Hg. Which of the following is the most likely cause of this type of pressure elevation?

a.

Vasospasm

b.

Rigidity of the aorta

c.

Decreased sodium intake

d.

Lung disease

ANS: B

Older adults experience stiffening of the arteries, which could lead to hypertension.

A vasospasm could lead to chest pain, not hypertension.

Increased sodium intake, not decreased, could lead to increased blood volume and hypertension.

Lung disease would not lead to hypertension.

REF: p. 587

8. A 52-year-old male is diagnosed with primary hypertension. He has no other health problems. Present treatment would cause the nurse to anticipate administering which drug to the patient?

a.

A beta-adrenergic agonist

b.

An alpha-adrenergic agonist

c.

A diuretic

d.

A calcium channel agonist

ANS: C

Diuretics have been shown to be the safest and most effective medications for lowering blood pressure and preventing the cardiovascular complications of hypertension.

Diuretics have been shown to be the safest and most effective medications for lowering blood pressure and preventing the cardiovascular complications of hypertension. A beta-adrenergic drug would be used for patients with other concurrent health problems.

Diuretics have been shown to be the safest and most effective medications for lowering blood pressure and preventing the cardiovascular complications of hypertension. An alpha-adrenergic drug would be used for patients with other concurrent health problems.

Diuretics have been shown to be the safest and most effective medications for lowering blood pressure and preventing the cardiovascular complications of hypertension. A calcium channel agonist drug would be used for patients with other concurrent health problems.

REF: p. 591

9. A 55-year-old female has undiagnosed hypertension. She presents to her primary care provider reporting impaired vision and chronic edema. Lab tests reveal that she also has renal insufficiency. While planning care, the nurse realizes the most likely cause for these findings is:

a.

Clotting and gangrene

b.

Free radical injury and cell toxicity

c.

End-organ damage

d.

Hypertrophy and hyperplasia

ANS: C

The patient is experiencing end-organ damage, as indicated by renal insufficiency.

The patient is not experiencing gangrene, but end-organ damage.

The patient is experiencing end-organ damage; it is not due to the formation of free radicals.

Hypertrophy and hyperplasia could develop, but the cause of the patients symptoms is end-organ damage.

REF: p. 590

10. A nurse monitors the patient for _____ when rapid onset of malignant hypertension results.

a.

Atherosclerosis

b.

Encephalopathy

c.

Pulmonary edema

d.

Acute renal failure

ANS: B

Malignant hypertension leads to cerebral edema and cerebral dysfunction (encephalopathy) and even death.

Malignant hypertension leads to cerebral edema; atherosclerosis does not.

Malignant hypertension could lead to heart failure, which could lead to pulmonary edema, but encephalopathy occurs more frequently.

Malignant hypertension could lead to heart failure, which could lead to renal failure, but encephalopathy occurs more frequently.

REF: p. 590

11. When a nurse checks the patient for orthostatic hypotension, what did the nurse have the patient do?

a.

Physical exertion

b.

Eat

c.

Stand up

d.

Lie down

ANS: C

Orthostatic hypotension refers to a drop in blood pressure when standing up.

Orthostatic hypotension refers to a drop in blood pressure when standing up, not a drop with exertion.

Orthostatic hypotension refers to a drop in blood pressure when standing up, not a drop with eating.

Orthostatic hypotension refers to a drop in blood pressure when standing up, not with lying down.

REF: p. 591

12. A 50-year-old male is diagnosed with orthostatic hypotension. Which of the following symptoms would he most likely experience?

a.

Headache and blurred vision

b.

Nausea and vomiting

c.

Chest pain and palpitations

d.

Syncope and fainting

ANS: D

Orthostatic hypotension is often accompanied by dizziness, blurring or loss of vision, and syncope or fainting.

Orthostatic hypotension is often accompanied by dizziness, blurring or loss of vision, and syncope or fainting, not by headache or blurred vision, which are symptoms of hypertension.

Orthostatic hypotension is often accompanied by dizziness, blurring or loss of vision, and syncope or fainting, not nausea and vomiting.

Orthostatic hypotension is often accompanied by dizziness, blurring or loss of vision, and syncope or fainting, not chest pain and palpitations, which may be symptomatic of myocardial infarction.

REF: p. 591

13. A 65-year-old female 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.

REF: p. 592

14. A 60-year-old male 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.

Cerebral aneurysms often occur in the circle of Willis, not the vertebral arteries.

Cerebral aneurysms often occur in the circle of Willis, not the basilar artery.

Cerebral aneurysms often occur in the circle of Willis, not the carotid arteries.

REF: p. 592

15. What term should the nurse document for a detached blood clot?

a.

Thrombus

b.

Embolus

c.

Thromboembolus

d.

Infarction

ANS: C

A detached thrombus is a thromboembolus.

A thrombus is a clot that remains attached to a vessel wall; a detached thrombus is a thromboembolus.

An embolus is a bolus of material floating in the blood stream; a detached thrombus is a thromboembolus.

An infarction is death of tissue; a detached thrombus is a thromboembolus.

REF: p. 593

16. A 32-year-old female presents with lower leg pain, with swelling and redness. While obtaining the patients history, which finding could have caused her condition?

a.

Venous thrombus

b.

Heart valve damage

c.

Bacterial infection

d.

Atherosclerosis

ANS: A

A thrombus formation in the vein leads to inflammation that may cause pain and redness with obstruction. Increased pressure in the vein behind the clot may lead to edema of the extremity.

Heart valve damage may lead to thrombus, but it is not the cause of the patients symptoms.

The patient is experiencing a venous thrombus that leads to the swelling, redness, and pain. A bacterial infection would not cause these localized specific symptoms.

Atherosclerosis causes narrowing, primarily of arteries, but this is a venous thrombus that is causing the patients symptoms.

REF: pp. 592-593

17. A 28-year-old female presents with severe chest pain and shortness of breath. She is diagnosed with pulmonary embolism, which most likely originated from the:

a.

Left ventricle

b.

Systemic arteries

c.

Deep veins of the leg

d.

Superficial veins of the arm

ANS: C

The most likely origin of the embolism is from the deep veins of the legs.

The most likely origin of the embolism is from the deep veins of the legs, not from the left ventricle.

The most likely origin of the embolism is from the deep veins of the legs, not the systemic arteries.

The most likely origin of the embolism is from the deep veins of the legs, not from the arms.

REF: p. 593

18. Individuals with Raynaud disease need to be counseled to avoid which of the following conditions to prevent severe symptoms?

a.

Allergic reactions

b.

Cold exposure

c.

Hot water immersion

d.

Tissue injury

ANS: B

Raynaud disease consists of vasospastic attacks triggered by brief exposure to cold.

Raynaud disease demonstrates symptoms when extremities are exposed to cold. It is not an allergic reaction.

Raynaud disease demonstrates symptoms when extremities are exposed to cold. It is not due to hot water immersion.

Raynaud disease demonstrates symptoms when extremities are exposed to cold. It is not the result of tissue injury.

REF: p. 594

19. 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 patients 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.

REF: p. 585

20. A 52-year-old male presents with pooling of blood in the veins of the lower extremities and edema. The diagnosis is chronic venous insufficiency, and an expected assessment finding of this disorder is:

a.

Deep vein thrombus formation

b.

Skin hyperpigmentation

c.

Gangrene

d.

Edema above the knee

ANS: B

Symptoms include edema of the lower extremities and hyperpigmentation of the skin of the feet and ankles. Edema in these areas may extend to the knees.

Symptoms include edema and hyperpigmentation of the skin, but deep vein thrombi do not form.

Gangrene does not occur in veins, but in arteries.

Edema does not occur above the knee.

REF: p. 586

21. While planning care for a patient with superior vena cava syndrome (SVCS), which principle should the nurse remember? SVCS is a progressive _____ of the superior vena cava (SVC) that leads to venous distention of the upper extremities and head.

a.

Inflammation

b.

Occlusion

c.

Distention

d.

Sclerosis

ANS: B

SVCS is a progressive occlusion of the SVC that leads to venous distention in the upper extremities and head.

SVCS is a progressive occlusion, not inflammation, of the SVC that leads to venous distention in the upper extremities and head.

SVCS is a progressive occlusion, not distention, of the SVC that leads to venous distention in the upper extremities and head.

SVCS is a progressive occlusion, not sclerosis, of the SVC that leads to venous distention in the upper extremities and head.

REF: p. 586

22. A 50-year-old male with a 30-year history of smoking was diagnosed with bronchogenic cancer. He developed edema and venous distention in the upper extremities and face. Which of the following diagnosis will the nurse observe on the chart?

a.

Thromboembolism

b.

Deep vein thrombosis

c.

Superior vena cava syndrome (SVCS)

d.

Chronic venous insufficiency

ANS: C

SVCS is a progressive occlusion of the superior vena cava that leads to venous distention in the upper extremities and head.

Thromboembolism would not lead to the generalized symptoms described in the patient.

Deep vein thrombosis would not lead to upper extremity symptoms.

Chronic venous insufficiency would primarily affect one extremity.

REF: p. 586

23. A 52-year-old female 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 to ischemia.

Coronary artery disease can contribute to necrosis, but obstruction by a clot would more likely lead to necrosis.

Coronary artery disease would lead to myocardial ischemia, not inflammation.

REF: p. 587

24. A 56-year-old male 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; cigarette smoking leads to vasoconstriction and should be the first behavior the patient changes.

The living arrangement of the patients home would not lead to the development of coronary artery disease; cigarette smoking leads to vasoconstriction and should be the first behavior the patient changes.

Drinking tomato juice would not lead to the development of coronary artery disease; cigarette smoking leads to vasoconstriction and should be the first behavior the patient changes.

REF: p. 594

25. A 50-year-old obese male with hypertension and coronary artery disease visits a nutritionist for food counseling. He has an elevated level of low-density lipoprotein (LDL) and a low level of high-density lipoprotein (HDL). Which of the following should the nurse advise him to avoid?

a.

Monounsaturated fats

b.

Polyunsaturated fats

c.

Saturated fats

d.

Trans fats

ANS: D

Trans fats are primarily found in artificially solidified (hydrogenated) oils (e.g., margarine and vegetable shortening). By becoming more solid, they lose essential fatty acids (EFAs). They can raise LDL and lower HDL levels.

Trans fats, not monounsaturated fats, are primarily found in artificially solidified (hydrogenated) oils (e.g., margarine and vegetable shortening). By becoming more solid, they lose EFAs. They can raise LDL and lower HDL levels.

Trans fats, not polyunsaturated fats, are primarily found in artificially solidified (hydrogenated) oils (e.g., margarine and vegetable shortening). By becoming more solid, they lose EFAs. They can raise LDL and lower HDL levels.

Trans fats, not saturated fats, are primarily found in artificially solidified (hydrogenated) oils (e.g., margarine and vegetable shortening). By becoming more solid, they lose EFAs. They can raise LDL and lower HDL levels.

REF: p. 598

26. When a patient asks the nurse what is the most common cause of myocardial ischemia, which statement is the correct response? The most common cause of myocardial ischemia is:

a.

Idiopathic vasospasm

b.

Arterial emboli from heart valve

c.

Atherosclerosis

d.

Venous emboli

ANS: C

The most common cause of myocardial ischemia is atherosclerosis.

Atherosclerosis, not vasospasm, is the major cause of myocardial ischemia.

Arterial emboli may cause ischemia, but atherosclerosis is the major cause of myocardial ischemia.

Venous emboli would not lead to myocardial ischemia; atherosclerosis is the major cause of myocardial ischemia.

REF: p. 600

27. A 51-year-old male presents with recurrent chest pain on exertion. He is diagnosed with angina pectoris. When he asks what causes the pain, how should the nurse respond? 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.

REF: p. 601

28. 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.

REF: p. 601

29. 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 to 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.

REF: p. 601

30. A 49-year-old male presents to his primary care provider 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

Increase myocardial oxygen supply is indicated to treat ischemia.

Oxygen is indicated, not a decrease in volume.

Heart rate should be decreased to decrease cardiac workload.

Antibiotics are not the most beneficial; oxygen is.

REF: p. 603

31. 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, but it is an indication of impending MI.

Unstable angina could be caused by altered electrical conduction, but it is an indication of impending MI.

Unstable angina is due to a decrease in myocardial oxygen, but it is an indication of impending MI.

REF: p. 604

32. 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 is most likely occlusion of the coronary artery, not emboli from the aorta.

The cause is most likely occlusion of the coronary artery, not decreased filling time.

The cause is most likely occlusion of the coronary artery, not dysplasia in the artery.

REF: p. 604

33. A 60-year-old female had a myocardial infarction. She was brought to the hospital 30 minutes later. She survived, but now 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.

REF: p. 611

34. A 75-year-old male has severe chest pain and dials 911. Lab tests at the hospital reveal elevated levels of cardiac troponins I and T. Based upon the lab findings, the nurse suspects which of the following has occurred?

a.

Raynaud disease

b.

Myocardial infarction (MI)

c.

Orthostatic hypotension

d.

Varicose veins

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.

Elevated troponins I and T are indicative of MI, not orthostatic hypotension.

Elevated troponins I and T are indicative of MI, not varicose veins.

REF: p. 609

35. A 28-year-old female presents to the ER reporting severe chest pain that worsens with respirations or lying down. She has a fever, tachycardia, and a friction rub. Based upon the assessment findings, the nurse determines the patient is experiencing:

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 respiration; the patient is experiencing symptoms of pericarditis.

Stable angina does not worsen with respiration or lying down; the patient is experiencing symptoms of pericarditis.

Pericardial effusion is not manifested by these symptoms; the patient is experiencing symptoms of pericarditis.

REF: p. 609

36. A 56-year-old male 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 is 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 could present without symptoms; tamponade presents with muffled heart sounds.

Pulsus paradoxus is manifested by a change in blood pressure during inspiration and expiration.

REF: p. 610

37. A 42-year-old female 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.

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 pathophysiological changes in the heart. In constrictive pericarditis, fibrous scarring compresses the heart and eventually reduces cardiac output.

Hemorrhage in the pericardial cavity will lead to tamponade. In constrictive pericarditis, fibrous scarring compresses the heart and eventually reduces cardiac output.

REF: p. 611

38. 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 dysfunction?

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.

Valvular dysfunction is often related to rheumatic fever; heart failure decreases cardiac output, but does not affect valvular function.

Valvular dysfunction is often related to rheumatic fever; it is not due to connective tissue disorders.

Valvular dysfunction is often related to rheumatic fever; syphilis infection could affect valves, but it is not the most common.

REF: p. 612

39. While planning care, the nurse remembers which principle? In valvular _____, the valve opening is constricted and narrowed because the valve leaflets, or cusps, 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 where it came.

Valvular incompetence leads to regurgitation.

REF: p. 612

40. A 67-year-old female was previously diagnosed with rheumatic heart disease. Tests reveal lipoprotein deposition with chronic inflammation that impairs blood flow from the left ventricle into the aorta. Which of the following is the most likely diagnosis recorded on the chart?

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.

REF: p. 613

41. A 60-year-old female was diagnosed with mitral stenosis. As a result, the nurse realizes the patient 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.

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

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

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

REF: p. 614

42. A 72-year-old female 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.

REF: p. 614

43. Upon assessment of the patient, the nurse finds a widened pulse pressure and throbbing peripheral pulses. Which valve disorder does the nurse suspect?

a.

Mitral regurgitation

b.

Mitral stenosis

c.

Aortic regurgitation

d.

Aortic stenosis

ANS: C

Aortic regurgitation is manifested by widened pulse pressure resulting from increased stroke volume and diastolic backflow.

Mitral regurgitation is manifested by heart failure.

Mitral stenosis is manifested by pulmonary edema and heart failure.

Aortic stenosis is manifested by narrowed pulse pressure.

REF: p. 614

44. A 35-year-old male presents with pulmonary hypertension. Testing reveals he is in right heart failure. Which of the following is the most likely diagnosis the nurse will see listed on the chart?

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.

REF: p. 615

45. A nurse recalls the most common cardiac valve disease in the United States, which tends to be most prevalent in young women, 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.

Mitral valve prolapse, not pulmonary stenosis, is the most common valve disorder in the United States.

Mitral valve prolapse, not tricuspid valve prolapse, is the most common valve disorder in the United States.

Mitral valve prolapse, not aortic stenosis, is the most common valve disorder in the United States.

REF: p. 615

46. A 10-year-old male presents with fever, lymphadenopathy, arthralgia, and nose bleeds. He is diagnosed with rheumatic heart disease. When a staff member asks what caused the disease, what is the nurses most correct response? The most likely cause of this disease is:

a.

Congenital heart defects

b.

Human immunodeficiency virus (HIV) infections

c.

Group A -hemolytic streptococcus infections

d.

Acute pericarditis

ANS: C

Rheumatic fever is a systemic, inflammatory disease caused by a delayed exaggerated immune response to infection by the group A -hemolytic streptococcus.

Rheumatic fever is a systemic, inflammatory disease caused by a delayed exaggerated immune response to infection by the group A -hemolytic streptococcus, not by congenital heart defects.

Rheumatic fever is a systemic, inflammatory disease caused by a delayed exaggerated immune response to infection by the group A -hemolytic streptococcus, not by HIV infections.

Rheumatic fever is a systemic, inflammatory disease caused by a delayed exaggerated immune response to infection by the group A -hemolytic streptococcus, not by acute pericarditis.

REF: p. 616

47. A 10-year-old male presents with fever, lymphadenopathy, arthralgia, and nose bleeds. He is diagnosed with rheumatic heart disease. While planning care, which characteristic changes should the nurse remember?

a.

Blood-borne organisms that adhere to the valvular surface

b.

Antigens that bind to the valvular lining, triggering an autoimmune response

c.

High fevers that damage collagen in valve leaflets

d.

Rheumatoid factor in the blood, stimulating valvular degeneration

ANS: B

The immune response cross-reacts with molecularly similar self-antigens in heart, muscle, joints, and the brain, causing an autoimmune response resulting in diffuse, proliferative, and exudative inflammatory lesions in these tissues.

The immune response cross-reacts with molecularly similar self-antigens in heart, muscle, and joints, and the brain, causing an autoimmune response resulting in diffuse, proliferative, and exudative inflammatory lesions in these tissues. It is not due to blood-borne organisms.

This immune response cross-reacts with molecularly similar self-antigens in heart, muscle, joints, and the brain, causing an autoimmune response resulting in diffuse, proliferative, and exudative inflammatory lesions in these tissues. It is not due to high fevers.

This immune response cross-reacts with molecularly similar self-antigens in heart, muscle, joints, and the brain, causing an autoimmune response resulting in diffuse, proliferative, and exudative inflammatory lesions in these tissues. It is not due to rheumatoid factors.

REF: p. 616

48. A 30-year-old female presents to her primary care provider with fever, cardiac murmur, and petechial skin lesions. She is diagnosed with infective endocarditis. When the patient wants to know what caused the disease, what is the nurses best response? The most likely cause of the disease is:

a.

Bacteria

b.

Viruses

c.

Fungi

d.

Parasites

ANS: A

Infective carditis is due to a bacterial infection.

Infective carditis is due to a bacterial infection, not a viral infection.

Infective carditis is due to a bacterial infection, not a fungus.

Infective carditis is due to a bacterial infection, not an infection caused by a parasite.

REF: p. 617

49. A nurse is teaching staff about endocarditis. Which information should the nurse include? 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.

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.

In endocarditis, bacterial colonies are inaccessible to host defenses because they are embedded in the protective fibrin clots; it is not because the valves are avascular.

In endocarditis, bacterial colonies are inaccessible to host defenses because they are embedded in the protective fibrin clots; it is not because the colonies overwhelm the phagocytes.

REF: p. 618

50. A 50-year-old male visits the cardiologist for an EKG. Results indicate that he has no PR interval and a variable QRS rate with rhythm irregularity. Which of the following is the most likely diagnosis to be recorded on the chart?

a.

Atrial tachycardia

b.

Atrial fibrillation

c.

Sinus dysrhythmia

d.

Idioventricular rhythm

ANS: B

Atrial fibrillation is characterized by no PR interval and a variable QRS response.

Atrial tachycardia is characterized by a normal PR interval.

Sinus dysrhythmia is characterized by a change in rhythm associated with inspiration and expiration.

Idioventricular dysrhythmia is characterized by absent P waves.

REF: p. 620

51. 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.

REF: p. 623

52. 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.

REF: p. 624

53. A 59-year-old female is diagnosed with left ventricular failure. If a decrease in kidney perfusion occurs, the nurse knows this would ultimately cause:

a.

Decreased left ventricular preload

b.

Increased pulmonary capillary permeability

c.

Increased systemic vascular resistance

d.

Decreased cardiac oxygen demand

ANS: C

With a decrease in kidney perfusion, renin is released with the ultimate outcome of increased systemic vascular resistance to raise blood pressure to increase blood flow to the kidney.

Ventricular preload will increase, not decrease.

Capillary permeability will likely decrease.

Cardiac oxygen demand will increase, not decrease.

REF: p. 607

54. A 68-year-old female is experiencing left heart failure. Physical exam reveals elevated blood pressure. The nurse understands this is most likely caused by:

a.

Sympathetic nervous system compensation for decreased cardiac output

b.

Stress hormones promoting increased cardiac contractility

c.

Cardiotoxic effects of catecholamines and angiotensin

d.

Diastolic dysfunction

ANS: A

The sympathetic nervous system increases peripheral vascular resistance (PVR) and leads to hypertension.

The sympathetic nervous system increases PVR and leads to hypertension. The stress hormones do not increase contractility.

The sympathetic nervous system increases PVR and leads to hypertension. Catecholamines and angiotensin increase blood pressure, but are not cardiotoxic.

The sympathetic nervous system increases PVR and leads to hypertension. Diastolic dysfunction does not lead to elevated blood pressure.

REF: p. 623

55. When a patient with left heart failure starts to have a cough and dyspnea, which principle should the nurse remember? 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.

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.

The clinical manifestations of left heart failure are the result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation. Decreased cardiac output does occur, but the pulmonary symptoms are related to pulmonary congestion.

The clinical manifestations of left heart failure are the result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation. They are not due to bronchoconstriction.

REF: p. 624

56. A 73-year-old female has increased pulmonary pressure resulting in right heart failure. The nurse should monitor for a possible complication because a potential cause for her 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.

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.

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 pneumonia.

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 pericarditis.

REF: p. 626

57. 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 failure

b.

Left heart failure

c.

Low-output failure

d.

High-output failure

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.

Pulmonary congestion leads to right-sided failure, not low-output failure.

Pulmonary congestion leads to right-sided failure, not high-output failure.

REF: p. 626

58. 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.

Right-sided failure allows blood to back up into the systemic circulation, leading to 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.

REF: p. 626

59. Which condition should cause the nurse to assess for high-output failure in a patient?

a.

Metabolic alkalosis

b.

Hypothyroidism

c.

Hypovolemia

d.

Anemia

ANS: D

Common causes of high-output failure include anemia.

Common causes of high-output failure include anemia, not metabolic alkalosis.

Common causes of high-output failure include anemia, not hypothyroidism.

Common causes of high-output failure include anemia, not hypovolemia.

REF: p. 626

60. When a person is in shock, a nurse remembers impairment in cellular metabolism is cause by:

a.

Release of toxic substances

b.

Free radical formation

c.

Inadequate tissue perfusion

d.

Lack of nervous or endocrine stimulation

ANS: C

In shock, impaired cellular metabolism is caused by inadequate tissue perfusion.

Impairment of cellular metabolism is the result of inadequate tissue perfusion; toxic substances could develop, but it would be secondary to the inadequate perfusion.

Free radicals are not the cause of impaired cellular metabolism.

Lack of inadequate tissue perfusion leads to impaired cellular metabolism; lack of nervous control would lead to vasodilation, but perfusion still occurs.

REF: p. 626

61. One consequence of switching from aerobic to anaerobic cellular metabolism during shock states is:

a.

Decreased adenosine triphosphate (ATP) production

b.

Cellular dehydration

c.

Cellular alkalosis

d.

Free radical formation

ANS: A

Anaerobic metabolism leads to decreased ATP production.

Anaerobic metabolism leads to decreased ATP production, not cellular dehydration.

Anaerobic metabolism leads to decreased ATP production, not cellular alkalosis.

Anaerobic metabolism leads to decreased ATP production, not free radical formation.

REF: p. 626

62. A nurse is planning care for a patient in shock. Which principle should the nurse remember? During shock states, glucose uptake is usually:

a.

Enhanced

b.

Normal

c.

Impaired

d.

Energy intensive

ANS: C

Some compensatory mechanisms activated by shock contribute to decreased glucose uptake by the cells.

Some compensatory mechanisms activated by shock contribute to decreased glucose uptake by the cells, not enhanced uptake.

Some compensatory mechanisms activated by shock contribute to decreased glucose uptake by the cells, not normal uptake.

Some compensatory mechanisms activated by shock contribute to decreased glucose uptake by the cells, not energy-intensive uptake.

REF: p. 628

63. A 50-year-old male was admitted to the intensive care unit with a diagnosis of acute myocardial infarction (MI). He is being treated for shock. His cardiopulmonary symptoms include low blood pressure, tachycardia, and tachypnea. His skin is pale and cool. The primary cause of his 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.

MI would lead to decreased contractility; a rapid heart rate would not cause shock.

MI would lead to decreased contractility; increased capillary permeability would not lead to shock.

Decreased afterload will not lead to shock associated with MI.

REF: p. 625

64. An 82-year-old female was admitted to the hospital with confusion and severe hypotension. Her bodys compensatory mechanisms are increased heart rate, vasoconstriction, and movement of large volumes of interstitial fluid to the vascular compartment. What kind of shock does the nurse suspect the patient is experiencing?

a.

Anaphylactic

b.

Hypovolemic

c.

Neurogenic

d.

Septic

ANS: B

In hypovolemic shock, heart rate and SVR increase, boosting both cardiac output and tissue perfusion pressures. Interstitial fluid moves into the vascular compartment.

In anaphylactic shock, bronchoconstriction occurs with hypotension.

In neurogenic shock, hypotension occurs, but fluid does not shift.

In septic shock, interstitial fluid shift does not occur.

REF: p. 630

65. A 27-year-old male is admitted to a neurologic unit with a complete C-5 spinal cord transection. On initial assessment, he is bradycardic, hypotensive, and hyperventilating. He appears to be going into shock. The most likely mechanism of his shock is:

a.

Hypovolemia caused by blood loss

b.

Hypovolemia caused by evaporative fluid losses

c.

Vasodilation caused by gram-negative bacterial infection

d.

Vasodilation caused by a decrease in sympathetic stimulation

ANS: D

The patient is experiencing neurogenic shock in which blood volume has not changed, but SVR decreases drastically so that the amount of space containing the blood has increased, leading to hypotension.

In this type of shock, blood loss has not occurred.

In this type of shock, fluid loss has not occurred.

Vasodilation due to infection would be septic shock; the type of shock described in the patient is due to loss of sympathetic stimulation.

REF: p. 631

66. What factors make a patient prone to neurogenic shock? Neurogenic shock can be caused by any factor that inhibits the:

a.

Parasympathetic nervous system

b.

Sympathetic nervous system

c.

Somatic nervous system

d.

Thalamus

ANS: B

Neurogenic shock is caused by any factor that inhibits the sympathetic nervous system.

Neurogenic shock is caused by any factor that overstimulates, not inhibits, the parasympathetic nervous system.

Neurogenic shock is not caused by inhibition of the somatic system.

Neurogenic shock is not caused by inhibition of the thalamus.

REF: p. 631

67. A 15-year-old male who is allergic to peanuts eats a peanut butter cup. He then goes into anaphylactic shock. Which assessment findings will the nurse assess for?

a.

Bradycardia, decreased arterial pressure, and oliguria

b.

Bronchoconstriction, hives or edema, and hypotension

c.

Hypertension, anxiety, and tachycardia

d.

Fever, hypotension, and erythematous rash

ANS: B

Anaphylactic shock is characterized by bronchoconstriction, hives, and hypotension.

Anaphylactic shock is characterized by bronchoconstriction, hives, and hypotension; it does not involve oliguria or bradycardia.

Anaphylactic shock is not manifested by hypertension, but hypotension.

Septic shock, not anaphylactic shock, is manifested by fever and rash.

REF: p. 631

68. A nurse is teaching a patient about anaphylactic shock. Which information should the nurse include? The onset of anaphylactic shock is usually:

a.

Mild

b.

Immediate and life threatening

c.

Delayed by several hours

d.

Delayed by 24 hours

ANS: B

The onset of anaphylactic shock is usually immediate and life threatening.

The onset of anaphylactic shock is immediate and aggressive, not mild.

The onset of anaphylactic shock is immediate; it is not delayed by hours.

The onset of anaphylactic shock is immediate; it is not delayed by 24 hours.

REF: p. 631

69. For an infection to progress to septic shock, which of the following factors should the nurse determine occurred?

a.

The individual must be immunosuppressed.

b.

The myocardium must be impaired.

c.

The infection must be gram negative.

d.

Bacteria must enter the bloodstream.

ANS: D

For septic shock to occur, bacteria must enter the bloodstream.

Septic shock can occur in individuals who are not immunosuppressed.

In septic shock, the myocardium is not impaired.

Many organisms in addition to gram-negative bacteria can cause septic shock.

REF: p. 632

70. A 20-year-old female is being admitted to the hospital with fever and septic shock. Which set of assessment findings would the nurse expect the patient to exhibit?

a.

Bradycardia, palpitations, confusion, truncal rash

b.

Severe respiratory distress, jugular venous distention, chest pain

c.

Low blood pressure, tachycardia, generalized edema

d.

Reduced cardiac output, increased systemic vascular resistance, moist cough

ANS: C

Clinical manifestations of shock will include a low blood pressure and tachycardia.

Tachycardia, not bradycardia, will occur.

Severe respiratory distress, jugular vein distention, and chest pain are symptoms of heart failure, particularly pulmonary edema.

Cardiac output is reduced, but there is a decrease in systemic vascular resistance.

REF: p. 629

71. The hypotensive state seen in septic shock can lead to:

a.

Bradycardia due to an overworked heart

b.

Gut lining disruption and the translocation of bacteria into the bloodstream

c.

Decreased oxygen demand of highly metabolic tissue

d.

The increased spread of infection

ANS: B

Gastrointestinal mucosa changes cause the translocation of bacteria from the gut into the bloodstream.

Tachycardia, rather than bradycardia, occurs.

The hypotensive state would lead to an increased demand of all tissues.

The hypotensive state would decrease the spread of infection.

REF: pp. 633-634

72. Which patient is most prone to multiple organ dysfunction syndrome (MODS)? In a patient with:

a.

Myocardial infarction (MI)

b.

Pulmonary disease

c.

Septic shock

d.

Autoimmune disease

ANS: C

The most common cause of MODS is septic shock.

The most common cause of MODS is septic shock, not MI.

The most common cause of MODS is septic shock, not pulmonary disease.

The most common cause of MODS is septic shock, not autoimmune disease.

REF: p. 633

73. A 75-year-old female has been critically ill with multiple organ dysfunction syndrome (MODS) for longer than a week and has developed a severe oxygen supply and demand imbalance. The statement that best describes this imbalance is which of the following?

a.

Increased oxygen delivery to cells fails to meet decreased oxygen demands.

b.

The amount of oxygen consumed by cells depends only on the needs of cells, because there is oxygen in reserve.

c.

The situation results in supply-independent consumption.

d.

The reserve has been exhausted, and the amount of oxygen consumed depends on the amount the circulation is able to deliver.

ANS: D

In MODS, the reserve has been exhausted and the body cannot meet the oxygenation demands.

It is true that oxygen fails to meet demand, but there is no increase in oxygen because reserves are exhausted.

There is no oxygen in reserve.

The situation is supply and demand, but the demand cannot be met.

REF: p. 634

74. Which organ should the nurse monitor closely since it is often the first to fail in patients with multiple organ dysfunction syndrome (MODS)?

a.

Liver

b.

Heart

c.

Lungs

d.

Pancreas

ANS: C

The lungs are the first to fail in MODS.

The lungs, not the liver, are the first to fail in MODS.

The lungs, not the heart, are the first to fail in MODS.

The lungs, not the pancreas, are the first to fail in MODS.

REF: p. 636

75. Which of the following findings in the patient with Raynaud disease would indicate a need for further teaching?

a.

The patient eats bananas twice a day.

b.

The patient smokes cigarettes.

c.

The patient wears mittens outside.

d.

The patient takes calcium channel blockers.

ANS: B

Cigarette smoking should be stopped to eliminate the vasoconstricting effects of nicotine.

Cigarette smoking should be stopped to eliminate the vasoconstricting effects of nicotine. The bananas do not cause problems in this patient.

Cigarette smoking should be stopped to eliminate the vasoconstricting effects of nicotine. The patient should wear mittens outside.

Cigarette smoking should be stopped to eliminate the vasoconstricting effects of nicotine. Calcium channel blockers are acceptable treatment for Raynaud disease.

REF: p. 94

76. Which of the following lab tests will the nurse check to help diagnose heart failure and provide insight into its severity?

a.

Renin level

b.

Brain natriuretic

c.

Potassium

d.

Troponin

ANS: B

The level of serum brain natriuretic peptide (BNP) can also help make the diagnosis of heart failure and give some insight into its severity.

Renin levels would not assist in the diagnosis of heart failure, but are elevated in hypertension.

Potassium levels would not assist with the diagnosis of heart failure.

Troponin assists in the diagnosis of myocardial infarction.

REF: p. 600

MULTIPLE RESPONSE

1. A nurse recalls acute orthostatic hypotension can be caused by (select all that apply):

a.

Prolonged immobility

b.

Drug action

c.

Starvation

d.

Volume depletion

e.

Exercise

ANS: A, B, C, D

Acute orthostatic hypotension occurs as a result of drug action, prolonged immobility, starvation, and volume depletion. Physical exhaustion, rather than exercise, could cause orthostatic hypotension.

REF: p. 591

COMPLETION

1. A patient has been researching cardiac cells on the internet. Which information indicates the patient has a good understanding? Cardiac cells can withstand ischemic conditions for _____ minutes before irreversible cell injury occurs.

ANS:

20

twenty

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

REF: p. 604

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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