Cardiovascular

Question 1

Which BP-regulating mechanism(s) can result in the development of hypertension if defective? (Select all that apply)

a. Release of norepinephrine
b. Secretion of prostaglandins PGE2 and PGI2
c. Stimulation of the sympathetic nervous system
d. Stimulation of the parasympathetic nervous system
e. Activation of the renin–angiotensin–aldosterone system

Answer 1

A,C,E

Question 2

2. While obtaining subjective assessment data from a client with hypertension, the nurse recognizes which of the following as a modifiable risk factor for the development of hypertension?
   a. Hyperlipidemia
   b. Excessive alcohol intake
   c. A family history of hypertension
   d. Consumption of a high-carbohydrate, high-calcium diet

Answer 2

B

Question 3

3. The nurse includes which of the following ideas in teaching a client with hypertension about controlling the condition?
   a. All clients with elevated BP require medication.
   b. It is not necessary to limit salt in the diet if taking a diuretic.
   c. Obese people must achieve a normal weight in order to lower BP.
   d. Lifestyle modifications are indicated for all people with elevated BP.

Answer 3

D

Question 4

4. What is a major consideration in the management of an older adult with hypertension?
   a. Prevent pseudohypertension from converting to true hypertension.
   b. Recognize that older adults are less likely to adhere to the drug therapy than younger adults.
   c. Ensure that the client receives larger initial doses of antihypertensive drugs because of impaired absorption.
   d. Use careful technique in assessing the BP of the client because of the possible presence of an auscultatory gap.

Answer 4

D

Question 5

5. A client with newly diagnosed hypertension has a blood pressure of 158/98 mm Hg after 12 months of exercise and diet modifications. How does the nurse advise the client?
   a. Medication may be required because the BP is still not within the normal range.
   b. Continued monitoring of the BP every 3 to 6 months is all that will be necessary for treatment.
   c. Because lifestyle modifications were not effective, they do not need to be continued and drugs will be used.
   d. The client will have to make more vigorous changes in lifestyle if the client wants to stay off medication for hypertension.

Answer 5

A

Question 6

6. A patient is admitted to the hospital in hypertensive emergency (BP 244/142 mm Hg). Sodium nitroprusside is started to treat the elevated BP. Which management strategy(ies) would be appropriate for this patient? (Select all that apply)
   a. Measuring hourly urine output.
   b. Decreasing the MAP by 50% within the first hour.
   c. Continuous BP monitoring with an intraarterial line.
   d. Maintaining bed rest and providing sedation to lower the BP.
   e. Assessing the patient for signs and symptoms of heart failure and changes in mental status.

Answer 6

A, C, E

Question 7

1. What are the manifestations of HF-REF that the nurse should recognize?
   a. ↓ Afterload and ↓ left ventricular end-diastolic pressure (LVEDP)
   b. ↓ Ejection fraction (EF) and ↑ pulmonary artery occlusive pressure (PAOP)
   c. ↓ PAOP and ↑ left ventricular EF
   d. ↑ Pulmonary hypertension associated with normal EF

Answer 7

B

Question 8

2. Which compensatory mechanism leads to inappropriate sodium and fluid retention?
   a. Ventricular dilation
   b. Ventricular hypertrophy
   c. Neuro-hormonal response
   d. Sympathetic nervous system activation

Answer 8

C

Question 9

3. Which drug used in the management of a client with acute pulmonary edema will decrease both preload and afterload and provide relief of anxiety?
   a. Morphine
   b. Amiodarone
   c. Dobutamine
   d. Aminophylline

Answer 9

A

Question 10

4. How can a client with chronic HF best decrease the chances of having an acute decompensation?
   a. Resting and not making any exertions except under medical supervision
   b. Documenting fluid intake and urinary output each day
   c. Monitoring weight daily and reporting changes outside of recommended parameters
   d. Taking extra furosemide when shortness of breath occurs

Answer 10

C

Question 11

5. Clients with a heart transplant are at risk for which complications in the first year after transplantation? (Select all that apply)
   a. Cancer
   b. Infection
   c. Rejection
   d. Vasculopathy
   e. Sudden cardiac death

Answer 11

B, C, E

Question 12

7. What is a common cause of aortic valve stenosis in older adults?
   a. Rheumatic fever
   b. Cardiomyopathy
   c. Congenital heart disease
   d. Acute infective endocarditis

Answer 12

A

Question 13

8. Which of the following findings is indicative of left ventricular overload in a client with chronic aortic regurgitation?
   a. Dehydration and a pericardial friction rub
   b. An audible third heart sound and a midsystolic murmur
   c. Exertional dyspnea and a diastolic high-pitched murmur
   d. An audible third heart sound and a pansystolic or holosystolic murmur

Answer 13

C

Question 14

9. A client hospitalized with aortic stenosis has a nursing diagnosis of activity intolerance related to imbalance between oxygen supply/demand. Which of the following is an appropriate nursing intervention for this client?
   a. Monitoring electrocardiogram to assess cardiac output
   b. Maintaining client on bed rest to reduce tissue oxygen demands
   c. Progressively increasing activity to increase cardiac tolerance
   d. Using semi-Fowler’s position to decrease venous return and increase respiratory excursion.

Answer 14

C

Question 15

10. What should the nurse caring for a client scheduled for a mitral valve replacement with a mechanical valve understand about this procedure?
    a. It is similar to a commissurotomy.
    b. It requires long-term anticoagulation therapy.
    c. It is the treatment of choice for an older-adult client with a history of falling.
    d. It involves the insertion of a transventricular dilator into the opening of the valve.

Answer 15

B

Question 16

11. Which of the following assessment findings would the nurse expect in a client with dilated cardiomyopathy?
    a. Dyspnea and fatigue
    b. Wheezing and epigastric pain
    c. Palpitations and left lower quadrant tenderness
    d. Excessive sputum and lower abdominal cramping

Answer 16

A

Question 17

12. The nurse plans care for a client with dilated cardiomyopathy based on what knowledge?
    a. Family members may be at risk because of the infectious nature of the disease.
    b. Medical management of the disorder focuses on treatment of the underlying cause.
    c. The prognosis of the client is poor, and emotional support is a high priority of care.
    d. The condition may be successfully treated with surgical ventriculomyotomy and septal ablation.

Answer 17

C

Question 18

Pulmonic regurgitation

Answer 18

Blood flows backwards through incompetent pulmonic valve from pulmonary artery to RV

Question 19

Aortic Regurgitation

Answer 19

Stream of blood flows backwards from incompetent aortic valve into left ventricle during diastole

Question 20

What do regurgitations cause

Answer 20

Murmurs

Question 21

Mitral Stenosis

Answer 21

Calcified Mitral valve does not open properly impedes forward flow of blood into LV during diastole results in swollen LA

Question 22

Tricuspid Stenosis

Answer 22

Calcified tricuspid valve impedes forward flow into RV during diastole

Question 23

Tricuspid regurgitation

Answer 23

Backflow of blood through incompetent tricuspid valves into RA

Question 24

Mitral regurgitation

Answer 24

Stream of blood regurgitates back into LA during systole through incompetent mitral valve

Question 25

Pulmonic Stenosis

Answer 25

Calcification of pulmonic valve restricts forward flow of blood

Question 26

Aortic Stenosis

Answer 26

Calcification of aortic valve cusps restricts forward flow of blood during systole

Question 27

Thrill

Answer 27

Occurs in the 2nd and 3rd interspaces they are palpable vibrations due to turbulent blood flow

Question 28

Heaves

Answer 28

Are lifts that occurring at the left sternal border they are typically associated with pulmonic conditions. They are also related to forceful contractions

Question 29

Volume Overload

Answer 29

Cardiac enlargement displaces the apical impulse

Question 30

Pressure overload

Answer 30

Does not necessarily displace the impulse but it is increased in force and duration

Question 31

A nurse is caring for a patient who has newly-diagnosed hypertension and has a history of diabetes and increased cholesterol. Which statement(s) regarding treatment of hypertension is true? Select all that apply.

A. The patient should be started immediately on level two treatments due to existing co-morbidities.
B. A goal of treatment is to reduce the volume of circulating blood.
C. A goal of treatment is to increase the amount of vascular resistance.
D. A goal of treatment is to increase the release of water and sodium.
E, Cardiac medications are the most effective treatment against hypertension.

Answer 31

A, B, D

Question 32

Which statement regarding a murmur is correct?

A. It is an extra heart sound created by the closure of the valves.
B. It always follows a cardiac disease process.
C. It can be caused by a sudden increase in blood flow.
D. It is best heard with the diaphragm over the pulmonic valve.

Answer 32

C

Question 33

A nurse is caring for a patient with left-sided chronic heart failure. Which clinical manifestation(s) should the nurse anticipate? Select all that apply.

A. Congested cough
B. 2+ pitting edema
C. Jugular venous distention
D. Decreased oxygenation
E. Wheezing on auscultation

Answer 33

A, D , E

Question 34

Which patient should the nurse assess first?

A. A 76-year-old female who has heart failure, is suddenly confused, with increased respirations and a congested, frothy cough.
B. A 31-year-old pregnant female with a newly discovered murmur.
C. A. A 54- year- old male who has a current BP of 157/83 mmHg and is due for a hypertensive medication.
D. A 79- year-old male who has heart failure, with 2+ peripheral edema and moderate shortness of breath on exertion.

Answer 34

A