Chapter 8: Chest Disorders

Question 1

In mitral stenosis, p waves may suggest:

Answer 1

Left atrial enlargement

Question 2

Aortic regurgitation requires medical treatment for early signs of CHF with:

Answer 2

ACE inhibitors

Question 3

A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because:

Answer 3

A & B only

Question 4

The best evidence rating drugs to consider in a post myocardial infarction patient include:

Answer 4

ASA, ACE/ARB, beta-blocker, aldosterone blockade

Question 5

A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include:

Answer 5

Exercise stress test

Question 6

Preceding a stress test, the following lab work might include:

Answer 6

A & C only

Question 7

Which test is the clinical standard for the assessment of aortic stenosis?

Answer 7

Echocardiography

Question 8

What is the most common valvular heart disease in the older adult?

Answer 8

Aortic stenosis

Question 9

Ischemic heart disease is:

Answer 9

All of the above.

Question 10

On examination, what type of murmur can be auscultated with aortic regurgitation?

Answer 10

Austin flint

Question 11

Which test is the clinical standard for the assessment of aortic stenosis?

Answer 11

Echocardiography

Question 12

The aging process causes what normal physiological changes in the heart?

Answer 12

The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis

Question 13

An older adult may present with atypical clinical signs of pneumonia. The nurse practitioner needs to be aware that the clustering of all of the following signs and symptoms may be indicative of pneumonia in an older person except:

Answer 13

Bradycardia

Question 14

Which of the following statements is true concerning anti-arrhythmic drugs?

Answer 14

Most anti-arrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic.

Question 15

Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely?

Answer 15

Coronary artery disease with angina pectoris

Question 16

ose M. is a 68-year-old man who presents to your primary care practice for a physical. Jose has had type 2 diabetes mellitus for 5 years, diet controlled. His BMI is 32. Smoker, pack per day for 25 years. He denies other medical problems. Family history includes CAD, CABG x4 for father, now deceased; CHF, type 2 diabetes mellitus, HT for mother. According to the AHA/ACC guidelines, what stage is Jose?

Answer 16

Stage A

Question 17

Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process?

Answer 17

Chronic bronchitis

Question 18

The best way to diagnose structural heart disease/dysfunction non-invasively is:

Answer 18

Echocardiogram

Question 19

A common auscultatory finding in advanced CHF is:

Answer 19

S3 gallop rhythm

Question 20

The organism most commonly responsible for community-acquired pneumonia in older adults is:

Answer 20

Streptococcus pneumonia

Question 21

A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely?

Answer 21

Pulmonary embolism