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NUR251 - Medical Surgical III > Exam 2 > Flashcards

Exam 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the primary cause of heart failure (HF)?

a) High cholesterol
b) Myocardial insult
c) Diabetes
d) Obesity

A

b) Myocardial insult

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2
Q

Which term describes the percentage of total blood volume in the left ventricle (LV) at the end of diastole that is pumped out of the LV with the next systole?

a) Cardiac output (CO)
b) Stroke volume (SV)
c) Left ventricular ejection fraction (LVEF)
d) End-diastolic volume (EDV)

A

c) Left ventricular ejection fraction (LVEF)

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3
Q

Which condition is NOT commonly associated with heart failure (HF)

a) Hypertension (HTN)
b) Coronary artery disease (CAD)
c) Myocardial infarction (MI)
d) Chronic obstructive pulmonary disease (COPD)

A

d) Chronic obstructive pulmonary disease (COPD)

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4
Q

Heart failure with reduced ejection fraction (HFrEF) is due to a defect in which function?

a) Ventricular diastolic function/filling
b) Ventricular systolic function/contraction
c) Atrial contraction
d) Venous return

A

b) Ventricular systolic function/contraction

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5
Q

What are the primary risk factors for heart failure (HF)?

a) Diabetes and obesity
b) Hypertension (HTN) and coronary artery disease (CAD)
c) Advanced age and smoking
d) Vascular disease and metabolic syndrome

A

b) Hypertension (HTN) and coronary artery disease (CAD)

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6
Q

Which factor is considered a modifiable risk factor for HF and should be aggressively treated?

a) Coronary artery disease (CAD)
b) Hypertension (HTN)
c) Diabetes
d) Advanced age

A

b) Hypertension (HTN)

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7
Q

Which of the following conditions does NOT contribute to the development of heart failure (HF)?

a) Septal defects
b) Sarcoidosis
c) Viral myocarditis
d) Chronic kidney disease

A

d) Chronic kidney disease

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8
Q

Which of the following best describes the hallmark of heart failure with reduced ejection fraction (HFrEF)?

A. Increased blood pressure and volume retention

B. Decreased left ventricular ejection fraction (LVEF)

C. Increased preload and ventricular contractility

D. Normal LVEF and preserved diastolic function

A

B. Decreased left ventricular ejection fraction (LVEF)

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9
Q

What is the primary cause of right-sided heart failure (HF)?

A. Left-sided HF
B. Pulmonary embolism
C. Myocardial infarction of the right ventricle
D. Cor pulmonale

A

A. Left-sided HF

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10
Q

A patient with heart failure experiences peripheral edema, hepatomegaly, and jugular venous distention (JVD). These findings are consistent with which of the following?

A. Left-sided HF
B. HFrEF only
C. Right-sided HF
D. HFpEF only

A

C. Right-sided HF

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11
Q

A patient with HF presents with pulmonary congestion and edema. Which type of HF is most likely present?

A. Right-sided HF
B. Biventricular HF
C. Left-sided HF
D. Diastolic dysfunction only

A

C. Left-sided HF

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12
Q

Patients with HFpEF typically have which characteristic?

A. Low left ventricular ejection fraction (LVEF)
B. Stiff and noncompliant left ventricle
C. Increased afterload due to valvular disease
D. High blood pressure without fluid overload

A

B. Stiff and noncompliant left ventricle

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13
Q

Which of the following is a common cause of HFpEF?

A. Diabetes mellitus
B. Cardiomyopathy
C. Chronic hypertension
D. Pulmonary embolism

A

C. Chronic hypertension

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14
Q

Which finding is typically observed in biventricular HF?

A. Only left ventricular dysfunction
B. Decreased systemic venous pressure
C. Dysfunction of both ventricles and systemic venous engorgement
D. Reduced perfusion to only the lungs

A

C. Dysfunction of both ventricles and systemic venous engorgement

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15
Q

What clinical manifestation would most likely occur due to increased pulmonary hydrostatic pressure in left-sided HF?

A. Pulmonary congestion

B. Peripheral edema

C. Hepatomegaly

D. Jugular venous distention (JVD)

A

A. Pulmonary congestion

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16
Q

A patient with HF develops hyponatremia. What is the primary cause of this electrolyte imbalance in HF?

A. Reduced aldosterone levels
B. Decreased renin release
C. Ventricular hypertrophy
D. Increased fluid retention due to ADH secretion

A

D. Increased fluid retention due to ADH secretion

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17
Q

Which clinical manifestation is most commonly associated with right-sided heart failure?

a. Jugular venous distention (JVD)
b. Pulmonary congestion
c. Dyspnea on exertion
d. Orthopnea

A

a. Jugular venous distention (JVD)

Rationale: Right-sided heart failure leads to fluid backing up into the venous system, causing signs such as peripheral edema, hepatomegaly, and jugular venous distention.

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18
Q

Which peptide is released in response to increased cardiac wall stretching in heart failure?

a. Endothelin
b. Aldosterone
c. Catecholamines
d. Brain natriuretic peptide (BNP)

A

d. Brain natriuretic peptide (BNP)

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19
Q

What is the primary hormonal effect of natriuretic peptides in heart failure?

a. Increased aldosterone secretion
b. Stimulation of renin secretion
c. Inhibition of aldosterone and renin secretion
d. Stimulation of antidiuretic hormone (ADH) release

A

c. Inhibition of aldosterone and renin secretion

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20
Q

Which complication is a common result of biventricular heart failure?

a. Peripheral vasodilation
b. Increased cardiac output
c. Systemic venous engorgement
d. Decreased BNP levels

A

c. Systemic venous engorgement

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21
Q

Which finding is characteristic of ventricular remodeling in heart failure?

a. Decreased ventricular mass
b. Enlargement and increased sphericity of the ventricles
c. Reduced myocardial fibrosis
d. Increased LVEF

A

b. Enlargement and increased sphericity of the ventricles

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22
Q

Which therapy is used to prevent or reverse ventricular remodeling in HF?

a. Cardiac resynchronization therapy (CRT)
b. Calcium channel blockers
c. Loop diuretics
d. Antiarrhythmic drugs

A

a. Cardiac resynchronization therapy (CRT)

Rationale: CRT and other therapies like ACE inhibitors and beta-blockers have been shown to improve outcomes by reducing or reversing ventricular remodeling.

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23
Q

What triggers the release of endothelin in heart failure?

a. Hypoxia, ischemia, and inflammatory cytokines
b. Increased oxygen levels
c. Elevated atrial pressure
d. Low levels of aldosterone

A

a. Hypoxia, ischemia, and inflammatory cytokines

Rationale: Endothelin is a vasoconstrictive peptide released in response to factors like hypoxia, ischemia, and neurohormonal and inflammatory signals, which can negatively affect heart contractility.

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24
Q

What is acute decompensated heart failure (ADHF) characterized by?

a. A sudden increase in HF symptoms and decreased functional status

b. Gradual worsening of heart failure symptoms over months

c. Exclusively pulmonary symptoms without systemic effects

d. Improved sodium excretion through the kidneys

A

a. A sudden increase in HF symptoms and decreased functional status

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25
Q

What is the primary cause of pulmonary edema in ADHF?

a. Right-sided heart failure
b. Dehydration
c. Left-sided heart failure
d. Peripheral edema

A

c. Left-sided heart failure

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26
Q

What clinical sign is most sensitive and specific for elevated left ventricular (LV) filling pressures?

a. Crackles on lung auscultation
b. Jugular venous distention (JVD)
c. Pink, frothy sputum
d. Rapid heart rate

A

b. Jugular venous distention (JVD)

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27
Q

Which symptom may indicate the early stages of pulmonary congestion in ADHF?

a. Cyanosis
b. Coughing
c. Bradycardia
d. Warm extremities

A

b. Coughing

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28
Q

Which of the following symptoms may be observed in patients with severe pulmonary edema?

a. Bright red sputum
b. Pink, frothy sputum
c. Yellow, thick sputum
d. Clear, watery sputum

A

b. Pink, frothy sputum

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29
Q

Which hemodynamic classification is the most common presentation in patients with ADHF?

a. Dry-cold
b. Wet-cold
c. Dry-warm
d. Wet-warm

A

d. Wet-warm

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30
Q

What does a “wet” patient in the context of ADHF indicate?

a. Volume overload with symptoms like congestion and dyspnea

b. The patient is experiencing excessive perspiration

c. The patient has a fever

d. Presence of hypotension and cool extremities

A

a. Volume overload with symptoms like congestion and dyspnea

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31
Q

Which respiratory sign is often seen in ADHF patients during auscultation of the lungs?

a. Absence of breath sounds
b. Wheezing and crackles
c. Clear lung fields
d. Dull percussion notes

A

b. Wheezing and crackles

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32
Q

Why might the absence of crackles not rule out ADHF in some patients?

a. It indicates a different underlying disease

b. Crackles are never a common sign in ADHF

c. Patients with chronic HF may develop increased lymphatic drainage of alveolar edema

d. It means the patient is fully compensated

A

c. Patients with chronic HF may develop increased lymphatic drainage of alveolar edema

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33
Q

What causes hoarseness (Ortner sign) in patients with ADHF?

a. Compression of the recurrent laryngeal nerve from an enlarged left atrium

b. Fluid accumulation in the alveoli

c. Severe respiratory alkalosis

d. Sudden drop in blood pressure

A

a. Compression of the recurrent laryngeal nerve from an enlarged left atrium

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34
Q

What is chronic heart failure primarily associated with?

a) Increased cardiac output (CO) and decreased venous pressure

b) Reduced cardiac output (CO) and increased venous pressure

c) Increased pulmonary function and muscle hypertrophy

d) Decreased inflammation and vasodilation

A

b) Reduced cardiac output (CO) and increased venous pressure

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35
Q

Which compensatory mechanism occurs early in chronic HF to maintain cardiac output?

a) Decreased heart rate
b) Increased blood volume
c) Tachycardia
d) Vasodilation

A

c) Tachycardia

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36
Q

What is the primary cause of dyspnea in chronic HF patients?

a) Bronchial constriction
b) Increased pulmonary pressures from interstitial and alveolar edema
c) Hyperventilation
d) Reduced renal function

A

b) Increased pulmonary pressures from interstitial and alveolar edema

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37
Q

What does orthopnea, a type of dyspnea, indicate in chronic HF?

a) Increased renal perfusion
b) A decrease in cardiac output while standing
c) High sodium intake
d) Fluid redistribution from the legs to the lungs when lying down

A

d) Fluid redistribution from the legs to the lungs when lying down

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38
Q

Why might chronic HF patients experience a chronic, nonproductive cough?

a) Pulmonary congestion
b) Increased mucus production
c) Allergic reactions
d) Bronchospasms

A

a) Pulmonary congestion

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39
Q

Which symptom may be seen as an early response to a reduced cardiac output?

a) Fatigue
b) Nausea
c) Increased appetite
d) Peripheral neuropathy

A

a) Fatigue

Rationale: Reduced CO and decreased blood flow to tissues cause fatigue and limited daily activity performance.

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40
Q

What are palpitations in chronic HF typically related to?

a) Chronic stress
b) Overhydration
c) High blood pressure
d) Dysrhythmias, such as atrial fibrillation (AF)

A

d) Dysrhythmias, such as atrial fibrillation (AF)

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41
Q

What is a possible indicator of volume overload in chronic HF?

a) Weight loss
b) Increased urine output during the day
c) Edema
d) Hypotension

A

c) Edema

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42
Q

Which of the following is a neurologic manifestation of chronic HF?

a) Night sweats
b) Dizziness and lightheadedness
c) Increased concentration
d) Decreased appetite

A

b) Dizziness and lightheadedness

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43
Q

Why might chronic HF patients experience mental status changes?

a) Cerebral hypoperfusion
b) Increased sympathetic stimulation
c) Chronic dehydration
d) Cerebral hypoperfusion and possible hypoxia

A

d) Cerebral hypoperfusion and possible hypoxia

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44
Q

What skin change is commonly observed in chronic HF patients?

a) Reddened, inflamed skin
b) Dusky or mottled skin
c) Yellowish tint to the eyes
d) Flushed cheeks

A

b) Dusky or mottled skin

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45
Q

What may cause chest pain in patients with chronic HF?

a) Reduced CO and myocardial stretch from volume overload

b) Excessive oxygen intake

c) High-sodium diet

d) Increased hemoglobin levels

A

a) Reduced CO and myocardial stretch from volume overload

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46
Q

What is a potential cause of nocturia in chronic HF?

a) Increased renal perfusion in the supine position
b) Increased daytime activity
c) Hormonal imbalance
d) High-sugar diet

A

a) Increased renal perfusion in the supine position

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47
Q

What does the presence of hepatomegaly in HF patients suggest?

a) Lung congestion only
b) Hypercalcemia
c) Fluid overload affecting the liver
d) Decreased renal function

A

c) Fluid overload affecting the liver

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48
Q

What causes sleep problems in chronic HF patients?

a) Increased daytime exercise
b) Sleep apnea, nocturia, or psychologic issues
c) High-salt intake before bedtime
d) decreased oxygen levels at night

A

b) Sleep apnea, nocturia, or psychologic issues

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49
Q

What should be assessed when HF patients experience a dry, chronic cough?

a) Use of ACE inhibitors and pulmonary conditions
b) History of food allergies
c) Previous dehydration episodes
d) Increased appetite during illness

A

a) Use of ACE inhibitors and pulmonary conditions

Rationale: ACE inhibitors can cause a chronic cough due to elevated bradykinin levels; other potential causes should be evaluated.

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50
Q

A patient presents with edema in the pedal and scrotal areas, hepatomegaly, and jugular vein distension (JVD). Which type of heart failure does this most likely indicate?

a) Left-sided heart failure
b) Right-sided heart failure
c) Congestive heart failure without specificity
d) Pulmonary edema

A

b) Right-sided heart failure

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51
Q

A patient with left-sided heart failure is most likely to present with which of the following respiratory findings?

a) Ascites and edema
b) Anorexia and RUQ pain
c) Crackles and a dry, hacking cough
d) Murmurs and JVD

A

c) Crackles and a dry, hacking cough

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52
Q

Which clinical finding is more commonly associated with left-sided heart failure rather than right-sided heart failure?

a) Hepatomegaly
b) Right ventricular heaves
c) Frothy, pink-tinged sputum
d) Weight gain

A

c) Frothy, pink-tinged sputum

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53
Q

A patient reports dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. These symptoms are indicative of which condition?

a) Left-sided heart failure
b) Right-sided heart failure
c) Pulmonary embolism
d) Anemia

A

a) Left-sided heart failure

Rationale: Dyspnea, orthopnea, and paroxysmal nocturnal dyspnea are classic symptoms of left-sided heart failure due to fluid accumulation in the lungs and pulmonary congestion.

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54
Q

A patient with right-sided heart failure reports anorexia and gastrointestinal (GI) bloating. What is the likely cause of these symptoms?

a) Increased appetite due to elevated sympathetic tone
b) Pressure on the diaphragm from abdominal fluid accumulation
c) Pulmonary congestion
d) Reduced perfusion to skeletal muscles

A

b) Pressure on the diaphragm from abdominal fluid accumulation

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55
Q

Which symptom would you expect to find in a patient with left-sided heart failure but not right-sided heart failure?

a) Weight gain
b) Hepatomegaly
c) Pulmonary crackles
d) Anasarca

A

c) Pulmonary crackles

Rationale: Pulmonary crackles result from fluid accumulation in the lungs and are a distinguishing feature of left-sided heart failure, whereas right-sided heart failure primarily leads to systemic congestion.

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56
Q

A patient with right-sided heart failure is experiencing RUQ (right upper quadrant) pain. This is most likely due to which underlying condition?

a) Pleural effusion
b) Pulmonary edema
c) Muscle cramping
d) Hepatomegaly from venous congestion

A

d) Hepatomegaly from venous congestion

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57
Q

Which of the following signs is associated with left ventricular hypertrophy and may be observed in left-sided heart failure?

a) Pulsus alternans
b) Anasarca
c) JVD
d) Right ventricular heaves

A

a) Pulsus alternans

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58
Q

Which of the following diagnostic tests provides the most comprehensive information regarding left ventricular ejection fraction (LVEF) in a patient with heart failure (HF)?

A. Chest X-ray
B. Echocardiogram
C. 6-minute walk test
D. Polysomnography

A

B. Echocardiogram

Rationale: An echocardiogram is a valuable, noninvasive diagnostic tool that offers detailed information about LVEF, chamber size, valve function, and other aspects of heart function in HF. A chest x-ray provides less specific information, while a 6-minute walk test assesses functional capacity, and polysomnography is used to evaluate sleep apnea.

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59
Q

When evaluating a patient with chronic HF, the healthcare provider may order BNP and NT-proBNP tests. The primary role of these laboratory studies is to:

A. Assess kidney function
B. Identify the presence of a pulmonary embolism
C. Correlate with the degree of left ventricular failure
D. Differentiate between acute coronary syndrome and HF

A

C. Correlate with the degree of left ventricular failure

Rationale: BNP and NT-proBNP levels correlate with the degree of left ventricular (LV) failure. Elevated levels are commonly seen in HF but can also increase due to other conditions, such as pulmonary embolism, renal failure, and acute coronary syndrome.

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60
Q

Which of the following diagnostic tests is often performed during a heart catheterization to evaluate for unexplained, new-onset HF due to possible infiltrative disease?

A. Cardiac MRI
B. Endomyocardial biopsy
C. MUGA scan
D. 12-lead ECG Correct

A

B. Endomyocardial biopsy

Rationale: An endomyocardial biopsy performed during heart catheterization is useful for identifying infiltrative or infective diseases that may cause unexplained, new-onset HF.

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61
Q

A patient undergoing evaluation for HF presents with elevated BNP levels. What should the nurse understand about the significance of this finding?

A. BNP levels are elevated exclusively due to heart failure.

B. Elevated BNP levels can only occur in acute HF exacerbations.

C. High BNP levels correlate with LV failure but can also be elevated by other conditions.

D. Baseline BNP levels are not necessary for interpreting lab results.

A

C. High BNP levels correlate with LV failure but can also be elevated by other conditions.

Rationale: While BNP and NT-proBNP levels generally correlate with LV failure, they can be elevated by conditions like pulmonary embolism, renal failure, and acute coronary syndrome. Establishing baseline BNP levels is helpful for accurate assessment.

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62
Q

In distinguishing between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), which of the following diagnostic tools is most beneficial?

A. Multigated acquisition (MUGA) scan
B. Chest X-ray
C. Echocardiogram
D. 12-lead ECG Correct

A

C. Echocardiogram

Rationale: An echocardiogram is instrumental in distinguishing between HFrEF and HFpEF by evaluating LVEF, chamber sizes, and overall heart function.

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63
Q

For a patient suspected of having sleep-related complications contributing to HF, which diagnostic study is most appropriate?

A. Polysomnography
B. 6-minute walk test
C. Cardiac catheterization
D. Cardiac MRI

A

A. Polysomnography

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64
Q

In addition to assessing chamber size and LVEF, an echocardiogram also provides valuable information about:

A. Kidney function and electrolyte balance
B. Cardiac valve function, wall thickness, and motion
C. Presence of pulmonary embolism
D. Baseline BNP and NT-proBNP levels

A

B. Cardiac valve function, wall thickness, and motion

Rationale: An echocardiogram offers detailed data about heart valve function, wall thickness, and motion, among other aspects. It does not assess kidney function or BNP levels directly.

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65
Q

A 6-minute walk test in a patient with HF is primarily used to assess:

A. Intracardiac pressures
B. Pulmonary artery pressures
C. Cardiac valve abnormalities
D. Functional exercise capacity and endurance

A

D. Functional exercise capacity and endurance

Rationale: The 6-minute walk test measures functional capacity and endurance in patients with HF, providing an idea of their overall functional status. It does not measure intracardiac pressures directly.

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66
Q

What is the primary goal of therapy for patients hospitalized with acute decompensated heart failure (ADHF)?

A. Providing nutritional education
B. Increasing blood glucose levels
C. Relieving symptoms and optimizing volume status
D. Reducing patient mobility

A

C. Relieving symptoms and optimizing volume status

Rationale: Therapy for ADHF focuses on relieving symptoms, optimizing volume status, supporting oxygenation, and end-organ perfusion, among other goals.

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67
Q

Which assessment finding would indicate fluid volume overload in a patient with ADHF?

A. Weight loss
B. Positive hepatojugular reflux test
C. Clear breath sounds
D. Absence of edema

A

B. Positive hepatojugular reflux test

Rationale: Fluid volume overload may be indicated by findings such as a positive hepatojugular reflux test, edema, JVD, crackles, hypoxia, and others.

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68
Q

For a stable patient with ADHF in the emergency department or telemetry unit, which of the following is an important part of ongoing monitoring?

A. Frequent intake, output, and daily weight measurements

B. Urine output assessment every 8 hours

C. Immediate placement of a pulmonary artery catheter

D. Weekly evaluation of serum electrolytes

A

A. Frequent intake, output, and daily weight measurements

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69
Q

In managing a patient with ADHF and dyspnea, what positioning technique should the nurse use to decrease venous return and improve thoracic capacity?

A. Trendelenburg position
B. Supine position
C. High-Fowler’s position with feet dangling
D. Prone position Correct

A

C. High-Fowler’s position with feet dangling

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70
Q

What is a sign of decreased perfusion in a patient with ADHF?

A. Hypertension
B. Warm extremities
C. Increased urine output
D. Cool extremities

A

D. Cool extremities

Rationale: Signs of decreased perfusion include hypotension, decreased urine output, cool extremities, altered mentation, and worsening renal and liver function tests.

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71
Q

Which intervention may be used to rapidly remove excess intravascular fluid and sodium in patients with volume overload who are unresponsive to diuretics?

A. Extracorporeal membrane oxygenation (ECMO)
B. Ventricular assist device (VAD)
C. Ultrafiltration or aquapheresis
D. Implantation of of CRT

A

C. Ultrafiltration or aquapheresis

Rationale: Ultrafiltration, or aquapheresis, is an option for volume overload unresponsive to diuretics, allowing for rapid fluid removal while maintaining hemodynamic stability.

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72
Q

Which statement about noninvasive positive pressure ventilation (e.g., BiPAP) in ADHF patients is accurate?

A. BiPAP increases preload and cardiac workload.
B. BiPAP is contraindicated in pulmonary edema.
C. BiPAP decreases preload and improves oxygenation.
D. BiPAP provides no benefit for respiratory distress.

A

C. BiPAP decreases preload and improves oxygenation.

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73
Q

Mechanical cardiac assist devices are typically used in patients with ADHF in which condition?

A. Mild fluid overload
B. Hemodynamically stable state
C. Only as a preventative measure
D. Worsening HF with hemodynamic instability

A

D. Worsening HF with hemodynamic instability

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74
Q

What is the purpose of an intraaortic balloon pump (IABP) in the management of ADHF?

A. Increase pulmonary artery pressures

B. Decrease cardiac workload through counterpulsation

C. Reduce urine output

D. Provide long-term support for ADHF

A

B. Decrease cardiac workload through counterpulsation

Rationale: IABP increases coronary blood flow and decreases cardiac workload through counterpulsation, making it useful for hemodynamically unstable patients.

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75
Q

ECMO therapy for ADHF is primarily used for:

A. Temporary support in refractory HF or as a bridge to heart transplant
B. Long-term mechanical support
C. Reducing intravascular volume
D. Treatment of mild heart failure symptoms

A

A. Temporary support in refractory HF or as a bridge to heart transplant

Rationale: ECMO provides short-term mechanical circulatory support in cases of refractory HF or cardiogenic shock and requires an ICU setting.

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76
Q

Which of the following is a nonpharmacologic therapy option for a patient with ADHF who is not responding to traditional interventions and meets specific criteria?

A. Hemodialysis
B. Implantation of cardiac resynchronization therapy (CRT)
C. ECMO therapy
D. Administration of intravenous diuretics

A

B. Implantation of cardiac resynchronization therapy (CRT)

Rationale: CRT, a biventricular pacemaker, may be considered in patients with ADHF who meet specific criteria and do not respond to traditional therapies, helping to improve heart function.

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77
Q

Which noninvasive strategy is often employed to improve oxygenation in severe cases of pulmonary edema associated with ADHF?

A. Noninvasive positive pressure ventilation (e.g., BiPAP)
B. Intubation and mechanical ventilation only
C. High-flow nasal cannula oxygen therapy
D. Simple nasal

A

A. Noninvasive positive pressure ventilation (e.g., BiPAP)

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78
Q

Which drug is considered the first line of treatment for patients with volume overload in Acute Decompensated Heart Failure (ADHF)?

A. Morphine
B. Vasodilators
C. Diuretics
D. Positive inotropes

A

C. Diuretics

Rationale: Diuretics are the first line of treatment for patients with volume overload as they help reduce sodium and water reabsorption, thereby decreasing intravascular volume.

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79
Q

What is the primary effect of IV loop diuretics in the treatment of ADHF?

A. Increase preload
B. Decrease intravascular volume
C. Increase afterload
D. Decrease myocardial contractility

A

B. Decrease intravascular volume

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80
Q

Which electrolyte levels should be continually monitored when a patient is on diuretic therapy for ADHF?

A. Sodium and chloride
B. Potassium and calcium
C. Magnesium and chloride
D. Potassium and magnesium

A

D. Potassium and magnesium

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81
Q

Which of the following drugs is a primary venodilator used in the treatment of ADHF?

A. Nitroprusside
B. Nesiritide
C. Nitroglycerin
D. Morphine

A

C. Nitroglycerin

Rationale: IV nitroglycerin is a primary venodilator that reduces blood return to the right side of the heart, decreasing preload.

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82
Q

What should be monitored frequently when titrating IV nitroglycerin in a patient with ADHF?

A. Heart rate
B. Respiratory rate
C. Blood pressure
D. Oxygen saturation

A

C. Blood pressure

Rationale: Blood pressure should be monitored often (every 5 to 10 minutes) when titrating IV nitroglycerin to avoid hypotension.

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83
Q

Which drug is a potent IV arterial vasodilator that reduces both preload and afterload in ADHF?

A. Nitroglycerin
B. Sodium nitroprusside
C. Nesiritide
D. Dopamine

A

B. Sodium nitroprusside

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84
Q

Which drug is used for the short-term treatment of ADHF after a failed response to IV diuretics?

A. Nitroglycerin
B. Sodium nitroprusside
C. Morphine
D. Nesiritide

A

D. Nesiritide

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85
Q

How does morphine help in the management of ADHF?

A. Dilates pulmonary and systemic blood vessels
B. Decreases myocardial oxygen demand
C. Increases myocardial contractility
D. Reduces electrolyte imbalances

A

A. Dilates pulmonary and systemic blood vessels

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86
Q

Which of the following is a selective β-agonist that works mainly on the β1-receptors in the heart?

A. Dopamine
B. Dobutamine
C. Norepinephrine
D. Milrinone

A

B. Dobutamine

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87
Q

What is the primary difference between dopamine and dobutamine in the treatment of ADHF?

A. Dopamine increases SVR, while dobutamine does not
B. Dobutamine increases urine output, while dopamine does not
C. Dopamine causes dysrhythmias, while dobutamine does not
D. Dobutamine is a phosphodiesterase inhibitor, while dopamine is not

A

A. Dopamine increases SVR, while dobutamine does not

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88
Q

Which of the following is a primary indication for milrinone use in ADHF?

A. Decrease fluid volume
B. Increase myocardial contractility
C. Reduce myocardial oxygen consumption
D. Improve electrolyte balance

A

B. Increase myocardial contractility

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89
Q

Which adverse effect is associated with milrinone therapy?

A. Hyperglycemia
B. Hyperkalemia
C. Dysrhythmias
D. Hypocalcemia

A

C. Dysrhythmias

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90
Q

When might Digoxin be added to the treatment regimen for ADHF?

A. When patients have low blood pressure
B. When fluid volume is excessive
C. When symptoms persist after other medications
D. When electrolyte imbalances are corrected

A

C. When symptoms persist after other medications

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91
Q

Which electrolyte levels must be maintained when administering digoxin for ADHF?

A. Sodium and chloride
B. Potassium and magnesium
C. Calcium and phosphate
D. Sodium and potassium

A

B. Potassium and magnesium

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92
Q

Which therapy helps improve oxygen saturation and relieve dyspnea in patients with HF?

A. Diuretics
B. ACE inhibitors
C. Supplemental oxygen
D. Beta-blockers

A

C. Supplemental oxygen

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93
Q

What is a key recommendation for patients with chronic HF to conserve energy?

A. Avoid all physical activity
B. Engage in intense exercise routines
C. Increase fluid intake
D. Physical and emotional rest

A

D. Physical and emotional rest

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94
Q

What type of exercise program is recommended for all patients with chronic HF?

A. High-intensity interval training
B. Endurance training
C. Weightlifting
D. Cardiac rehabilitation

A

D. Cardiac rehabilitation

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95
Q

Which of the following is the cornerstone of drug therapy in chronic HF?

A. Neurohormonal blockade
B. Calcium channel blockers
C. Anticoagulants
D. Antiplatelet agents

A

A. Neurohormonal blockade

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96
Q

Which drug is considered first-line for patients with HFrEF to decrease mortality and hospitalizations?

A. ACE inhibitors
B. Beta-blockers
C. ARBs
D. Diuretics

A

A. ACE inhibitors

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97
Q

Which beta-blocker is known to decrease mortality in patients with HFrEF?

A. Atenolol
B. Propranolol
C. Bisoprolol
D. Labetalol

A

C. Bisoprolol

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98
Q

What is the primary benefit of beta-blocker therapy in patients with HFrEF?

A. Reduction of fluid retention
B. Increase in left ventricular ejection fraction (LVEF)
C. Decrease in electrolyte imbalances
D. Reduction in myocardial ischemia

A

B. Increase in left ventricular ejection fraction (LVEF)

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99
Q

Which side effect of beta-blockers requires careful titration in patients with volume overload?

A. Reduced myocardial contractility
B. Increased heart rate
C. Hypertension
D. Hyperkalemia

A

A. Reduced myocardial contractility

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100
Q

What is a major side effect of neurohormonal blockade in chronic HF?

A. Hypercalcemia
B. Hypotension
C. Hypernatremia
D. Hypoglycemia

A

B. Hypotension

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101
Q

What is the primary benefit of diuretics in the management of HF?

A. Reduce symptoms of fluid overload
B. Increase myocardial contractility
C. Reduce blood pressure
D. Improve heart rate

A

A. Reduce symptoms of fluid overload

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102
Q

What is a potential side effect of loop diuretics?

A. Hyperkalemia
B. Hypercalcemia
C. Low serum potassium levels
D. Hypernatremia

A

C. Low serum potassium levels

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103
Q

In chronic HF, what is the primary goal when administering diuretics?

A. To achieve rapid weight loss
B. To increase myocardial contractility
C. To completely eliminate fluid retention
D. To maintain the lowest effective dose

A

D. To maintain the lowest effective dose

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104
Q

Which cardiac device is recommended for patients with an LVEF less than 35% to coordinate ventricular contractions?

A. Pacemaker
B. Implantable Cardioverter-Defibrillator (ICD)
C. Cardiac Resynchronization Therapy (CRT)
D. Ventricular Assist Device (VAD)

A

C. Cardiac Resynchronization Therapy (CRT)

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105
Q

Which cardiac device is used for primary prevention of sudden cardiac death (SCD) in patients with HFrEF?

A. Pacemaker
B. Implantable Cardioverter-Defibrillator (ICD)
C. Cardiac Resynchronization Therapy (CRT)
D. Ventricular Assist Device (VAD)

A

B. Implantable Cardioverter-Defibrillator (ICD)

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106
Q

Which parameter monitored remotely can indicate worsening heart failure?

A. Weight gain
B. BP
C. Increased HR trends
D. Decreased patient activity level

A

C. Increased HR trends

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107
Q

What can a PA sensor implanted during a right heart catheterization monitor?

A. Blood glucose levels
B. Pulmonary artery pressures (PAP)
C. Renal function
D. Serum sodium levels

A

B. Pulmonary artery pressures (PAP)

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108
Q

What is the general sodium intake restriction for heart failure patients?

A. 1 gram per day
B. 2 grams per day
C. 3 grams per day
D. 4 grams per day

A

B. 2 grams per day

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109
Q

When might fluid restrictions be necessary for heart failure patients?

A. For all HF patients
B. For patients with mild HF
C. For patients with no fluid retention
D. For stage D HF patients with persistent fluid retention

A

D. For stage D HF patients with persistent fluid retention

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110
Q

When should heart failure patients contact their healthcare provider regarding weight gain?

A. A weight gain of 1 lb over 2 days
B. A weight gain of 3 lb over 2 days
C. A weight gain of 1 lb over a week
D. A weight gain of 2 lb over a week

A

B. A weight gain of 3 lb over 2 days

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111
Q

Which over-the-counter (OTC) medications pose a significant risk to people with heart failure? (Select all that apply.)

A. Nonsteroidal antiinflammatory drugs (NSAIDs)
B. High-dose aspirin
C. Ephedrine
D. Acetaminophen
E. Pseudoephedrine

A

A. Nonsteroidal antiinflammatory drugs (NSAIDs)
B. High-dose aspirin
C. Ephedrine
E. Pseudoephedrine

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112
Q

What should be included in the assessment of a patient with heart failure? (Select all that apply.)

A. Current prescription medications
B. Over-the-counter (OTC) drugs
C. Diet history
D. Fluid intake
E. Chronic health problems

A

A. Current prescription medications
B. Over-the-counter (OTC) drugs
C. Diet history
E. Chronic health problems

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113
Q

Which clinical problems are associated with heart failure? (Select all that apply.)

A. Activity intolerance
B. Fatigue
C. Fluid imbalance
D. Enhanced tissue perfusion
E. Impaired cardiac function

A

A. Activity intolerance
B. Fatigue
C. Fluid imbalance
E. Impaired cardiac function

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114
Q

What are the priority problems for nursing care in a patient with heart failure? (SATA)

A. Decreased CO
B. Impaired oxygenation
C. Increased respiratory rate
D. Fluid overload

A

A. Decreased CO
B. Impaired oxygenation
D. Fluid overload

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115
Q

What are the overall goals for the patient with heart failure? (SATA)

A. Increase in symptoms
B. Decrease in peripheral edema
C. Decrease in exercise tolerance
D. No complications related to HF

A

B. Decrease in peripheral edema

D. No complications related to HF

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116
Q

What are common precipitating factors for acute decompensated heart failure (ADHF)? (Select all that apply.)

A. Respiratory infections
B. Dysrhythmias
C. Acute coronary syndrome
D. Uncontrolled HTN

A

all of the choices are correct

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117
Q

What are the goals of ambulatory heart failure care? (Select all that apply.)

A. Symptom management
B. Improved quality of life (QOL)
C. Reduced exercise tolerance
D. Identifying factors precipitating ADHF and hospitalization

A

A. Symptom management
B. Improved quality of life (QOL)
D. Identifying factors precipitating ADHF and hospitalization

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118
Q

What is the impact of heart failure on patients’ quality of life (QOL)? (Select all that apply.)

A. Improved exercise tolerance
B. Reduced ability to perform daily activities
C. Increased fatigue
D. Improved mental health

A

B. Reduced ability to perform daily activities
C. Increased fatigue

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119
Q

Which statements accurately describe heart failure with preserved ejection fraction (HFpEF)? (select all that apply)

a. Uncontrolled hypertension is a primary cause.

b. Left ventricular ejection fraction may be within normal limits.

c. The pathophysiology involves ventricular relaxation and filling.

d. Multiple evidence-based therapies have been shown to decrease mortality.

e. Therapies focus on symptom control and treatment of underlying conditions.

A

a. Uncontrolled hypertension is a primary cause.

b. Left ventricular ejection fraction may be within normal limits.

c. The pathophysiology involves ventricular relaxation and filling.

e. Therapies focus on symptom control and treatment of underlying conditions.

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120
Q

Which compensatory mechanism involved in both chronic heart failure and acute decompensated heart failure leads to fluid retention and edema?

a. Ventricular dilation
b. Ventricular hypertrophy
c. Increased systemic blood pressure
d. Renin-angiotensin-aldosterone activation

A

d. Renin-angiotensin-aldosterone activation

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121
Q

The nurse is caring for a patient with acute decompensated heart failure who is receiving IV dobutamine. Which drug action is expected? (select all that apply)

a. Raises the heart rate
b. Dilates renal blood vessels
c. Increases heart contractility
d. Acts as a selective β-agonist
e. Increases systemic vascular resistance

A

c. Increases heart contractility

d. Acts as a selective β-agonist

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122
Q

A patient with chronic heart failure and atrial fibrillation is treated with low-dose digitalis and a loop diuretic. Which actions would the nurse take to prevent complications of this drug combination? (select all that apply)

a. Monitor serum potassium levels.

b. Teach the patient how to take a pulse rate.

c. Keep an accurate measure of intake and output.

d. Withhold digitalis if the pulse rhythm is irregular.

e. Teach the patient about diet potassium restrictions.

A

a. Monitor serum potassium levels.

b. Teach the patient how to take a pulse rate.

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123
Q

Which factor is a significant barrier to hospice referrals for patients with stage D heart failure?

a. Family member refusal
b. Scarcity of hospice care
c. History of pacemaker placement
d. Difficulty in estimating prognosis

A

d. Difficulty in estimating prognosis

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124
Q

The hemodynamic changes the nurse expects to find after successful initiation of intraaortic balloon pump therapy include (select all that apply)

a. decreased SV.
b. decreased SVR.
c. decreased PAWP.
d. increased diastolic BP.
e. decreased myocardial O2 consumption.

A

b. decreased SVR.
c. decreased PAWP.
d. increased diastolic BP.
e. decreased myocardial O2 consumption.

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125
Q

A patient with chronic heart failure is prescribed carvedilol. What is the primary benefit of this medication?

A. Increased contractility of the heart
B. Reduced cardiac afterload and mortality
C. Prevention of ventricular remodeling
D. Increased renal perfusion and diuresis

A

B. Reduced cardiac afterload and mortality

Rationale: Carvedilol, a beta-blocker, reduces afterload and mortality in chronic heart failure patients.

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126
Q

A nurse is administering IV furosemide to a patient with acute decompensated heart failure (ADHF). Which assessment is most important during the infusion?

A. Monitoring urine output
B. Assessing potassium levels
C. Checking for hypotension
D. Measuring respiratory rate

A

C. Checking for hypotension

Rationale: Furosemide can cause rapid fluid loss, leading to hypotension and electrolyte imbalances.

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127
Q

A patient with heart failure is started on digoxin. What is the priority assessment before administering this medication?

A. Heart rate and rhythm
B. Respiratory rate
C. Urine output
D. Blood pressure

A

A. Heart rate and rhythm

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128
Q

What is the primary purpose of prescribing an ACE inhibitor to a patient with heart failure?

A. To decrease cardiac preload and afterload
B. To increase cardiac contractility
C. To reduce the risk of arrhythmias
D. To prevent diuretic resistance

A

A. To decrease cardiac preload and afterload

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129
Q

A patient with ADHF is receiving dobutamine. What is the desired outcome of this treatment?

A. Increased heart rate
B. Decreased systemic vascular resistance
C. Reduced myocardial oxygen demand
D. Improved contractility and cardiac output

A

D. Improved contractility and cardiac output

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130
Q

The expected outcome for a patient with ADHF receiving IV nitroglycerin is:

A. Decreased respiratory rate
B. Reduced preload and afterload
C. Increased peripheral vasoconstriction
D. Improved myocardial oxygen demand

A

B. Reduced preload and afterload

Rationale: Nitroglycerin reduces preload and afterload through vasodilation.

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131
Q

A patient is scheduled for an echocardiogram. What information can this test provide in heart failure?

A. Presence of pulmonary embolism
B. Left ventricular ejection fraction (LVEF)
C. Degree of coronary artery stenosis
D. Arterial blood gas (ABG) results

A

B. Left ventricular ejection fraction (LVEF)

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132
Q

Which laboratory finding is most indicative of heart failure?

A. Elevated D-dimer
B. Decreased serum sodium
C. Elevated BNP or NT-proBNP levels
D. Increased troponin levels

A

C. Elevated BNP or NT-proBNP levels

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133
Q

Which assessment finding in a patient with ADHF indicates severe respiratory compromise?

A. Pink, frothy sputum
B. Bilateral crackles at lung bases
C. Respiratory rate of 24 breaths/min
D. Use of accessory muscle

A

A. Pink, frothy sputum

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134
Q

A patient with chronic heart failure reports nocturia. What causes this symptom?

A. Increased pulmonary pressure during sleep
B. Redistribution of fluid when lying flat
C. Renal failure due to low cardiac output
D. Poor adherence to diuretic therapy

A

B. Redistribution of fluid when lying flat

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135
Q

A nurse assesses jugular venous distension (JVD) in a patient with heart failure. What does this finding indicate?

A. Left-sided heart failure
B. Pulmonary hypertension
C. Decreased systemic vascular resistance
D. Increased right atrial pressure

A

D. Increased right atrial pressure

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136
Q

A patient with heart failure reports a dry, hacking cough. Which condition is the most likely cause?

A. Pulmonary embolism
B. Chronic heart failure
C. Acute respiratory infection
D. Pericarditis

A

B. Chronic heart failure

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137
Q

A patient with ADHF has a BP of 80/50 mm Hg, HR 120 bpm, and cool extremities. What is the priority nursing action?

A. Administer IV diuretics
B. Begin dobutamine infusion
C. Obtain a 12-lead ECG
D. Start oxygen therapy

A

B. Begin dobutamine infusion

Rationale: Dobutamine is indicated to improve cardiac output in hypotensive patients with signs of poor perfusion.

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138
Q

Which intervention is most effective for managing fluid overload in a patient with heart failure?

A. Limiting sodium intake to 4 g/day
B. Encouraging increased oral fluid intake
C. Administering diuretics as prescribed
D. Performing daily chest physiotherapy

A

C. Administering diuretics as prescribed

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139
Q

A patient with heart failure is categorized as “wet and warm.” Which findings support this classification?

A. Pulmonary congestion with adequate perfusion
B. Fluid overload with decreased skin perfusion
C. Cool extremities and crackles in the lungs
D. Peripheral vasodilation and low cardiac output

A

A. Pulmonary congestion with adequate perfusion

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140
Q

A nurse is educating a patient on modifiable risk factors for coronary artery disease (CAD). Which of the following factors should the nurse emphasize? Select all that apply.

A. Tobacco use
B. Hyperlipidemia
C. Age
D. Hypertension
E. Family history of CAD

A

A. Tobacco use
B. Hyperlipidemia
D. Hypertension

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141
Q

Which patient would be at greatest risk for inadequate collateral circulation development in CAD?

A. A patient experiencing a slow, chronic arterial blockage

B. A patient with acute severe coronary spasm

C. A patient with long-term, mild hypertension

D. A patient undergoing gradual lifestyle changes to reduce risk factors

A

B. A patient with acute severe coronary spasm

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142
Q

Which of the following is considered a major risk factor for coronary artery disease (CAD)?

A. High serum LDL levels

B. Low serum HDL levels

C. High serum albumin levels

D. Low serum triglyceride levels

A

A. High serum LDL levels

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143
Q

A BMI greater than 30 kg/m2 and waist circumference over 40 inches for men is considered a risk factor for CAD because:

A. It increases LDL and triglyceride levels

B. It is linked with reduced physical activity

C. It lowers HDL levels more effectively than other factors

D. It decreases insulin resistance

A

A. It increases LDL and triglyceride levels

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144
Q

A modifiable risk factor for CAD that involves catecholamine release, elevated BP, and vessel inflammation is:

A. Low serum HDL levels

B. Smoking tobacco

C. High LDL cholesterol

D. Chronic renal disease

A

B. Smoking tobacco

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145
Q

Obesity often coexists with other CAD risk factors, including:

A. Decreased triglyceride levels

B. Low insulin resistance

C. Hypertension and high LDL levels

D. Increased heart rate and vasodilation

A

C. Hypertension and high LDL levels

146
Q

Which statement about managing high-risk persons for CAD is accurate?

A) Non-modifiable risk factors cannot influence CAD risk at all.

B) Patients should be encouraged to change all risk factors simultaneously.

C) Non-modifiable factors should be balanced by controlling modifiable risks.

D) Modifiable factors are less significant than genetic predisposition.

A

C) Non-modifiable factors should be balanced by controlling modifiable risks.

147
Q

A patient with multiple CAD risk factors is highly motivated to improve health. What should be the primary focus of teaching?

A) Avoiding tobacco and alcohol use

B) Starting multiple lifestyle changes simultaneously

C) Knowing how to reduce CAD risk factors

D) Limiting physical activity to reduce stress

A

C) Knowing how to reduce CAD risk factors

148
Q

What is a common barrier for patients in reducing CAD risk factors?

A) A lack of understanding about prescribed drugs

B) Over-motivation to change lifestyle habits

C) Misconceptions about CAD and lifestyle change impact

D) Insufficient access to environmental pollutants

A

C) Misconceptions about CAD and lifestyle change impact

149
Q

What should be emphasized in patient teaching to slow the progression of CAD?

a) Increasing calorie intake

b) Risk factor modification

c) Limiting physical activity

d) Avoiding all medications

A

b) Risk factor modification

150
Q

A patient presents with chest pain that occurs primarily during rest and is associated with smoking. Which type of angina is most likely?

A. Prinzmetal’s angina
B. Chronic stable angina
C. Microvascular angina
D. Unstable angina

A

A. Prinzmetal’s angina

Rationale: Prinzmetal’s angina is caused by coronary vasospasm, often occurring at rest and triggered by smoking or increased levels of certain substances.

151
Q

Which statement about chronic stable angina is true?

A. It is relieved by rest or nitroglycerin.
B. It lasts more than 10 minutes.
C. It is more common in women.
D. It occurs primarily at rest.

A

A. It is relieved by rest or nitroglycerin.

Rationale: Chronic stable angina is characterized by episodic chest pain provoked by exertion or stress and relieved by rest or nitroglycerin.

152
Q

A patient with a history of CAD reports episodic chest pain while shopping or performing daily activities. The patient denies any relief with physical rest. What is the most likely diagnosis?

A. Chronic stable angina
B. Prinzmetal’s angina
C. Microvascular angina
D. Unstable angina

A

C. Microvascular angina

Rationale: Microvascular angina is associated with ischemia in small coronary vessels and is often triggered by activities of daily living rather than physical exertion.

153
Q

Which of the following treatments is commonly used for Prinzmetal’s angina?

A. Beta-blockers
B. Calcium channel blockers
C. Aspirin only
D. Statins

A

B. Calcium channel blockers

Rationale: Long-acting nitrates and calcium channel blockers are used to prevent coronary vasospasm in Prinzmetal’s angina.

154
Q

A patient reports new-onset angina that occurs at rest and lasts more than 10 minutes. What is the most likely cause?

A. Chronic stable angina
B. Microvascular angina
C. Prinzmetal’s angina
D. Unstable angina

A

D. Unstable angina

Rationale: Unstable angina is characterized by new-onset or worsening chest pain that occurs at rest or with minimal exertion and persists for over 10 minutes.

155
Q

What distinguishes microvascular angina from chronic stable angina?

A. Microvascular angina is triggered by exertion.
B. Microvascular angina is more common in men.
C. Microvascular angina is triggered by activities of daily living.
D. Microvascular angina is relieved by beta-blockers.

A

C. Microvascular angina is triggered by activities of daily living.

Rationale: Microvascular angina is caused by ischemia in small coronary vessels and is often triggered by routine activities rather than physical exertion.

156
Q

A patient presents with chest pain triggered by exertion, which resolves with nitroglycerin. What type of angina does this suggest?

A. Chronic stable angina
B. Prinzmetal’s angina
C. Microvascular angina
D. Unstable angina

A

A. Chronic stable angina

Rationale: Chronic stable angina is provoked by exertion or stress and is relieved by rest or nitroglycerin.

157
Q

What factor is commonly associated with triggering Prinzmetal’s angina?

A. Stress
B. Daily activities
C. Smoking
D. Exercise

A

C. Smoking

158
Q

Which type of angina is associated with rupture of unstable plaque?

A. Chronic stable angina
B. Microvascular angina
C. Prinzmetal’s angina
D. Unstable angina

A

D. Unstable angina

159
Q

A patient is diagnosed with chronic stable angina. What should the nurse educate the patient about managing episodes of chest pain?

A. Use long-acting nitrates during pain episodes.

B. Stop activity and rest during episodes of pain.

C. Avoid all physical activity to prevent ischemia.

D. Take calcium channel blockers during pain episodes.

A

B. Stop activity and rest during episodes of pain.

Rationale: Chronic stable angina episodes are relieved by rest and nitroglycerin, as they result from an O2 supply/demand mismatch during exertion.

160
Q

Which symptom description is most consistent with chronic stable angina?

A) Sharp, localized chest pain worsened by deep breaths

B) Pressure or tightness in the chest that radiates to the jaw or arm, often provoked by physical activity

C) Pain that increases with changes in body position

D) Persistent pain that does not subside with rest

A

B) Pressure or tightness in the chest that radiates to the jaw or arm, often provoked by physical activity

161
Q

In which scenario should chronic stable angina be suspected?

A) Chest discomfort occurring predictably with exertion and relieved by rest

B) Sudden onset chest pain with syncope and arrhythmia

C) Persistent pain lasting hours that does not respond to rest

D) Pain that occurs solely at night without exertion

A

A) Chest discomfort occurring predictably with exertion and relieved by rest

162
Q

Which of the following ECG changes would you expect in a patient with chronic stable angina during ischemic episodes?

A) ST-segment depression and/or T wave inversion in two contiguous leads

B) ST-segment elevation in two contiguous leads

C) Q waves appearing in all leads

D) No changes observed in any leads

A

A) ST-segment depression and/or T wave inversion in two contiguous leads

163
Q

What is a common management strategy for chronic stable angina that occurs predictably upon awakening?

A) Avoiding morning medications

B) Exercising immediately upon awakening

C) Scheduling medications to achieve peak effects at the time angina is likely to occur

D) Delaying all activities until midday

A

C) Scheduling medications to achieve peak effects at the time angina is likely to occur

164
Q

Which patient population has a higher prevalence of silent ischemia?

A) Patients with hypertension

B) Patients with normal cholesterol levels

C) Patients under age 40

D) Patients with diabetes due to diabetic neuropathy

A

D) Patients with diabetes due to diabetic neuropathy

165
Q

Which of the following is a common characteristic of Prinzmetal’s angina?

a) Occurs with increased physical demand

b) Associated with CAD only

c) Occurs at rest without increased physical demand

d) Always occurs during exercise

A

c) Occurs at rest without increased physical demand

166
Q

Which of the following is a risk factor for developing Prinzmetal’s angina?

a) Diabetes
b) History of migraine headaches
c) High cholesterol
d) Family history of CAD

A

b) History of migraine headaches

Rationale: Risk factors for Prinzmetal’s angina include a history of migraine headaches, Raynaud’s phenomenon, and heavy smoking.

167
Q

What is a common precipitating factor for coronary artery spasm in Prinzmetal’s angina?

a) High-protein diet

b) Aerobic exercise

c) Alcohol consumption

d) Low blood pressure

A

c) Alcohol consumption

168
Q

Which of the following medications is used in the treatment of Prinzmetal’s angina?

a) Beta blockers
b) Calcium channel blockers
c) Diuretics
d) ACE inhibitors

A

b) Calcium channel blockers

169
Q

What characterizes microvascular angina in terms of coronary artery disease (CAD) and coronary spasm

a) Significant CAD and coronary spasm are always present
b) Chest pain occurs with significant CAD
c) Chest pain occurs without significant CAD or coronary spasm of a major coronary artery
d) Chest pain occurs only during rest

A

c) Chest pain occurs without significant CAD or coronary spasm of a major coronary artery

170
Q

How is chest pain in microvascular angina typically brought on?

a) During physical exertion
b) At rest
c) During sleep
d) After eating

A

a) During physical exertion

171
Q

What is the usual finding in cardiac catheterization for patients with microvascular angina?

a) Obstructive coronary disease in major coronary arteries
b) Significant coronary artery spasm
c) Complete blockage of major coronary arteries
d) No obstructive coronary disease in major coronary arteries

A

d) No obstructive coronary disease in major coronary arteries

172
Q

What is the goal of treatment for a patient admitted with angina?

a) Increase physical activity
b) Decrease O2 demand and/or increase O2 supply
c) Provide nutritional support
d) Administer antibiotics

A

b) Decrease O2 demand and/or increase O2 supply

173
Q

Which of the following measures should be taken first to provide prompt pain relief for a patient with chest pain?

a) Administer oral acetaminophen
b) Apply ice to the chest
c) Provide SL or IV NTG
d) Offer a sedative

A

c) Provide SL or IV NTG

174
Q

What might a new systolic murmur heard during an angina attack indicate?

a) Normal heart function
b) Ischemia of a papillary muscle of the mitral valve
c) Improved cardiac output
d) Dehydration

A

b) Ischemia of a papillary muscle of the mitral valve

175
Q

Which diagnostic test should be obtained to evaluate a patient with chest pain?

a) Blood glucose test
b) Abdominal ultrasound
c) Pulmonary function test
d) 12-lead ECG

A

d) 12-lead ECG

176
Q

Why is maintaining ideal body weight important for patients with angina?

a) To reduce medication dependence
b) To decrease the heart’s workload
c) To improve mental health
d) To eliminate the need for exercise

A

b) To decrease the heart’s workload

177
Q

What type of diet should be taught to patients with angina and their caregivers?

a) Low in salt and saturated fats
b) High in saturated fats
c) High in sugar
d) Low in fiber

A

a) Low in salt and saturated fats

178
Q

What should patients be taught to avoid to prevent angina attacks?

a) Regular physical activity
b) Reading books
c) Exposure to extremes of weather and eating large, heavy meals
d) Drinking water

A

c) Exposure to extremes of weather and eating large, heavy meals

179
Q

Which of the following is a short-acting nitroglycerin preparation used for an acute episode of angina?

a) Isosorbide dinitrate (Isordil)
b) Transdermal NTG patch
c) SL NTG tablet
d) Calcium channel blocker

A

c) SL NTG tablet

180
Q

What side effect is common with all nitrates and requires monitoring?

a) Hyperglycemia
b) Orthostatic hypotension
c) Hyperthermia
d) Tachycardia

A

b) Orthostatic hypotension

181
Q

Why is a 10- to 14-hour nitrate-free period scheduled for patients on long-acting nitrates?

a) To prevent nitrate tolerance
b) To increase medication absorption
c) To enhance physical performance
d) To reduce gastrointestinal side effects

A

a) To prevent nitrate tolerance

182
Q

Which medication is used as an ACE inhibitor for patients with chronic stable angina?

a) Amlodipine
b) Metoprolol succinate
c) Lisinopril
d) Ranolazine

A

c) Lisinopril

183
Q

Why is ranolazine (Ranexa) used in treating chronic angina?

a) It increases blood pressure
b) It prolongs QT interval
c) It treats chronic angina in patients who have not responded to other medications
d) It causes weight gain

A

c) It treats chronic angina in patients who have not responded to other medications

184
Q

A nurse is assessing a patient with suspected unstable angina. Which symptom is most concerning?

A. Pain lasting less than 5 minutes
B. Pain unrelieved by rest or nitroglycerin
C. Pain triggered by exercise
D. Pain that resolves with nitroglycerin

A

B. Pain unrelieved by rest or nitroglycerin

185
Q

Which diagnostic test is most commonly used to confirm the presence of angina?

A. Chest X-ray
B. Complete blood count (CBC)
C. Echocardiogram
D. Electrocardiogram (ECG)

A

D. Electrocardiogram (ECG)

Rationale: An ECG can reveal ischemic changes (e.g., ST depression or T-wave inversion) that occur during episodes of angina.

186
Q

What differentiates unstable angina from chronic stable angina?

A. Occurs only during physical exertion
B. Resolves with nitroglycerin
C. Pain is unpredictable and occurs at rest
D. Pain is relieved by rest

A

C. Pain is unpredictable and occurs at rest

187
Q

A patient with angina reports nausea and diaphoresis. What should the nurse do first?

A. Assess vital signs.
B. Administer nitroglycerin.
C. Perform an ECG.
D. Notify the healthcare provider.

A

A. Assess vital signs.

Rationale: Vital signs should be assessed to determine hemodynamic stability and guide subsequent interventions.

188
Q

A patient undergoing a stress test reports chest pain. What is the priority action?

A. Stop the test immediately.
B. Administer oxygen.
C. Call for the crash cart.
D. Encourage the patient to keep walking.

A

A. Stop the test immediately.

189
Q

Which medication is most appropriate for a patient with unstable angina to prevent platelet aggregation?

A. Morphine
B. Aspirin
C. Metoprolol
D. Atorvastatin

A

B. Aspirin

190
Q

A patient states, “I have chest pain when I’m stressed, but it stops when I relax.” What is the nurse’s best interpretation?

A. Stable angina
B. Unstable angina
C. Silent ischemia
D. Variant angina

A

A. Stable angina

191
Q

Which finding during a physical exam of a patient with angina requires immediate action?

A. Heart rate of 88 bpm
B. Oxygen saturation of 95% on room air
C. Patient reports a headache after nitroglycerin
D. Blood pressure of 90/60 mmHg after nitroglycerin

A

D. Blood pressure of 90/60 mmHg after nitroglycerin

Rationale: Hypotension following nitroglycerin administration can lead to inadequate tissue perfusion and requires prompt attention.

192
Q

A nurse is caring for a young, tall, thin male who is a smoker and has a history of asthma. Which of the following conditions is he at an increased risk for?

A. Spontaneous pneumothorax
B. Pleural effusion
C. Pulmonary embolism
D. Pneumonia

A

A. Spontaneous pneumothorax

Rationale: The patient’s risk factors, such as being tall and thin, male gender, smoking, and having a history of asthma, increase the likelihood of spontaneous pneumothorax due to the formation of small blebs on the lung surface.

193
Q

A patient with chronic obstructive pulmonary disease (COPD) is diagnosed with a spontaneous pneumothorax. Which of the following is the most likely cause of the pneumothorax?

A. Rupture of small blebs on the lung surface
B. A severe asthma attack
C. An underlying pneumonia infection
D. Pulmonary embolism

A

A. Rupture of small blebs on the lung surface

Rationale: In COPD patients, spontaneous pneumothorax often occurs due to the rupture of small blebs, which are air-filled sacs that can form on the surface of the lungs.

194
Q

A nurse is teaching a patient with a history of spontaneous pneumothorax about risk factors. Which statement by the patient indicates a need for further education?

A. “I should avoid smoking to prevent bleb formation.”

B. “Being tall and thin can increase my risk for pneumothorax.”

C. “I am at higher risk because I have asthma.”

D. “A previous spontaneous pneumothorax doesn’t increase my risk for future ones.”

A

D. “A previous spontaneous pneumothorax doesn’t increase my risk for future ones.”

Rationale: Having a previous spontaneous pneumothorax actually increases the risk of having another one, so the statement shows a misunderstanding and requires further education.

195
Q

A 25-year-old male patient with no significant medical history presents with sudden chest pain and shortness of breath. He is tall and thin and has been smoking for several years. What is the most likely diagnosis?

A. Spontaneous pneumothorax
B. Acute asthma exacerbation
C. Myocardial infarction
D. Pulmonary embolism

A

A. Spontaneous pneumothorax

Rationale: This patient’s sudden chest pain and shortness of breath, combined with risk factors such as being tall and thin, smoking, and male gender, suggest spontaneous pneumothorax, especially since he has no significant medical history.

196
Q

A nurse is monitoring a patient with spontaneous pneumothorax who has been treated with oxygen therapy and observation. Which of the following would indicate that the patient’s condition is worsening?

A. Increase in respiratory rate and effort
B. Decrease in oxygen saturation
C. Sudden onset of sharp, localized chest pain
D. All of the above

A

D. All of the above

Rationale: Worsening spontaneous pneumothorax is indicated by increased respiratory rate and effort, decreased oxygen saturation, and sharp chest pain, as these signs suggest that the pneumothorax is not resolving and may require further intervention.

197
Q

A nurse is caring for a patient with a tension pneumothorax. Which of the following is the priority intervention for this condition?

A. Administer oxygen therapy

B. Perform needle decompression to relieve pressure

C. Start an intravenous line to administer fluids

D. Insert a chest tube to drain the pleural space

A

B. Perform needle decompression to relieve pressure

Rationale: Tension pneumothorax is a medical emergency requiring immediate intervention to relieve the pressure in the pleural space. Needle decompression is the first priority to restore pressure balance and prevent cardiovascular collapse.

198
Q

A patient with a tension pneumothorax is exhibiting signs of tracheal deviation and severe respiratory distress. The nurse understands that this is due to:

A. Increased venous return from the unaffected side
B. Pressure on the heart and great vessels from the trapped air
C. Decreased pressure on the unaffected lung
D. Rapid oxygenation of the affected lung

A

B. Pressure on the heart and great vessels from the trapped air

Rationale: In a tension pneumothorax, air enters the pleural space but cannot escape, causing pressure to build up. This pressure compresses the heart and great vessels, causing the mediastinum to shift and affecting both cardiac and respiratory function.

199
Q

A nurse is assessing a patient with suspected tension pneumothorax. Which of the following signs is the most concerning and requires immediate intervention?

A. Increased neck vein distention
B. Decreased breath sounds on the affected side
C. Severe dyspnea and marked tachycardia
D. Tracheal deviation to the unaffected side

A

D. Tracheal deviation to the unaffected side

Rationale: Tracheal deviation is a late sign of tension pneumothorax and indicates severe pressure in the pleural space. Immediate intervention is necessary to relieve the pressure and prevent further complications.

200
Q

A nurse is caring for a patient who sustained a trauma and is at risk for developing a tension pneumothorax. Which of the following actions may cause or exacerbate tension pneumothorax in this patient?

A. Clamping a chest tube in place
B. Administering high-flow oxygen
C. Inserting a nasogastric tube
D. Elevating the head of the bed

A

A. Clamping a chest tube in place

Rationale: Clamping a chest tube can obstruct the pleural drainage, leading to the accumulation of air and causing or exacerbating a tension pneumothorax, which can result in increased pressure and cardiovascular compromise.

201
Q

A patient with a tension pneumothorax is being prepared for needle decompression. The nurse prepares to insert the needle in which location?

A. Above the fifth intercostal space, midaxillary line
B. Second intercostal space, midclavicular line
C. Below the seventh rib, anterior axillary line
D. Fifth intercostal space, anterior axillary line

A

B. Second intercostal space, midclavicular line

Rationale: The appropriate location for needle decompression in a tension pneumothorax is the second intercostal space, midclavicular line, on the affected side. This allows for effective release of pressure in the pleural space.

202
Q

A nurse is monitoring a patient after successful needle decompression for tension pneumothorax. Which of the following findings would indicate that the patient is stabilizing?

A. Decreased neck vein distention
B. Tracheal deviation to the affected side
C. Increased breath sounds on the affected side
D. Decreased tachycardia and improved oxygenation

A

D. Decreased tachycardia and improved oxygenation

Rationale: After needle decompression, the reduction in intrapleural pressure should improve the patient’s oxygenation and decrease tachycardia, indicating that cardiovascular and respiratory function is stabilizing.

203
Q

A patient presents with a traumatic hemothorax following a motor vehicle accident. Which of the following is the priority intervention?

A. Administer pain medication
B. Prepare for chest tube insertion
C. Start intravenous fluids for hydration
D. Monitor for signs of infection

A

B. Prepare for chest tube insertion

Rationale: The priority intervention for a traumatic hemothorax is the insertion of a chest tube to evacuate the blood from the pleural space and prevent complications such as respiratory distress or hypovolemic shock.

204
Q

A patient with hemothorax is receiving autotransfusion of blood drained from the chest tube. What is the nurse’s primary concern during this procedure?

A. Risk of infection from the blood transfusion
B. Proper setup of the autotransfusion equipment
C. Potential for hemolysis of the transfused blood
D. Risk of fluid overload from reinfusion

A

B. Proper setup of the autotransfusion equipment

Rationale: The nurse’s primary concern is ensuring that the autotransfusion equipment is properly set up to safely reinfuse blood into the patient. Incorrect setup can lead to complications such as contamination or incorrect blood volume being reinfused.

205
Q

A nurse is caring for a patient with hemothorax who has a chest tube in place. Which of the following findings indicates that the patient may be experiencing a complication?

A. Constant bubbling in the chest tube drainage system
B. Decreased drainage of blood from the chest tube
C. Absence of breath sounds on the affected side
D. Increased blood drainage from the chest tube

A

D. Increased blood drainage from the chest tube

Rationale: Increased blood drainage from the chest tube may indicate ongoing bleeding or re-accumulation of blood in the pleural space, which could lead to hemodynamic instability and requires immediate evaluation.

206
Q

A patient with hemothorax is being monitored after chest tube insertion. Which of the following findings would be most concerning and require immediate intervention?

A. Blood-tinged drainage in the chest tube
B. A drop in hemoglobin and hematocrit levels
C. Mild pain at the chest tube insertion site
D. A decrease in the amount of drainage from the chest tube

A

B. A drop in hemoglobin and hematocrit levels

Rationale: A significant drop in hemoglobin and hematocrit levels suggests ongoing internal bleeding or insufficient evacuation of blood from the pleural space, which may require further intervention such as surgical evaluation.

207
Q

A patient with a suspected pneumothorax is being assessed. Which of the following findings is most indicative of a pneumothorax?

A. Subcutaneous emphysema
B. Tracheal deviation
C. Absence of breath sounds over the affected area
D. Hyperresonance on percussion

A

C. Absence of breath sounds over the affected area

Rationale: Breath sounds are absent over the affected area in a pneumothorax due to the presence of air in the pleural space preventing lung expansion.

208
Q

Which of the following would be a likely initial clinical manifestation of a small pneumothorax?

A. Severe chest pain
B. Mild tachycardia and dyspnea
C. Cyanosis
D. Hypotension

A

B. Mild tachycardia and dyspnea

Rationale: A small pneumothorax may present with mild tachycardia and dyspnea as the initial symptoms.

209
Q

What is the primary cause of a lung collapse in a pneumothorax?

A. Air entering the pleural cavity
B. Infection
C. Accumulation of fluid in the pleural space
D. Increased thoracic pressure from a cough

A

A. Air entering the pleural cavity

Rationale: A pneumothorax is caused by air entering the pleural cavity, which disrupts the negative pressure needed to keep the lungs inflated, leading to lung collapse.

210
Q

A patient presents with a penetrating chest wound described as a “sucking chest wound.” What is the immediate concern for this patient?

A. Risk of infection
B. Air entering the pleural space during inspiration
C. Fluid accumulation in the pleural space
D. Hypoxia due to decreased alveolar ventilation

A

B. Air entering the pleural space during inspiration

Rationale: A “sucking chest wound” allows air to enter the pleural space during inspiration, which can cause a pneumothorax and subsequent lung collapse.

211
Q

What diagnostic test is commonly used to confirm the presence of a pneumothorax?

A. MRI
B. CT Scan
C. Chest X-ray
D. Ultrasound

A

C. Chest X-ray

Rationale: A chest X-ray is commonly used to confirm the presence of a pneumothorax by showing air or fluid in the pleural space and reduced lung volume.

212
Q

A patient with a larger pneumothorax presents with respiratory distress. Which of the following signs would you expect to find upon assessment?

A. Decreased respiratory rate
B. Normal oxygen saturation
C. Eupnea
D. Shallow, rapid respirations

A

D. Shallow, rapid respirations

Rationale: A larger pneumothorax can cause significant respiratory distress, which often manifests as shallow, rapid respirations.

213
Q

A patient with a pneumothorax is being treated in the emergency department. The healthcare provider has instructed the nurse to apply a three-sided occlusive dressing to the chest wound. What is the purpose of this dressing?

A. To prevent further bleeding from the chest wound

B. To allow air to enter the pleural space during expiration

C. To prevent air from entering the pleural space during inspiration

D. To provide a sterile barrier over the open wound

A

C. To prevent air from entering the pleural space during inspiration

Rationale: A three-sided occlusive dressing allows air to escape from the wound during expiration but prevents air from entering the pleural space during inspiration, which is important in preventing the pneumothorax from worsening.

214
Q

A patient with a pneumothorax presents with mild dyspnea and stable vital signs. The healthcare provider decides to monitor the patient and not initiate any invasive treatment. Which of the following factors most likely influenced this decision?

A. The size of the pneumothorax is minimal.
B. The patient has a history of COPD.
C. The patient is experiencing severe chest pain.
D. The patient has poor renal function.

A

A. The size of the pneumothorax is minimal.

Rationale: A minimal pneumothorax with stable vital signs and mild symptoms may resolve on its own without the need for invasive treatment. The decision to monitor is based on the size of the pneumothorax and the patient’s hemodynamic stability.

215
Q

A pre-hospital care provider encounters a patient with a penetrating chest wound. What is the most appropriate action to take before transport to the hospital?

A. Remove the impaled object if it is causing respiratory distress.

B. Apply a non-occlusive dressing to the wound.

C. Secure the chest wound with a sterile bandage and no dressing.

D. Apply an occlusive dressing secured on three sides to the wound.

A

D. Apply an occlusive dressing secured on three sides to the wound.

Rationale: The occlusive dressing prevents air from entering the pleural space during inspiration, while allowing air to escape during expiration. This helps manage an open chest wound until the patient can be transported to a medical facility for further care.

216
Q

A patient with a pneumothorax is stable and is not experiencing significant symptoms. Which of the following actions should the nurse prioritize?

A. Prepare the patient for chest tube insertion.
B. Administer oxygen to the patient to improve oxygenation.
C. Reassure the patient that no immediate invasive intervention is required.
D. Initiate continuous cardiac monitoring.

A

C. Reassure the patient that no immediate invasive intervention is required.

Rationale: If the patient is stable and the pneumothorax is minimal, the nurse should reassure the patient that invasive interventions may not be necessary and that the condition may resolve on its own with monitoring.

217
Q

A patient with an open pneumothorax has a large, impaled object in the chest wound. The pre-hospital care provider stabilizes the object with a bulky dressing. What is the rationale for this intervention?

A. To prevent further damage to the lung tissue.
B. To reduce the risk of infection at the wound site.
C. To allow the wound to heal before transport.
D. To prevent the object from moving and causing further injury.

A

D. To prevent the object from moving and causing further injury.

Rationale: Stabilizing the impaled object with a bulky dressing helps prevent it from shifting, which could cause further damage to the lung or other organs. The object should not be removed in the pre-hospital setting.

218
Q

A nurse is providing education to a patient with a spontaneous pneumothorax. Which statement by the nurse is appropriate regarding the possible resolution of the condition?

A. “The pneumothorax will definitely require chest tube insertion.”

B. “Your condition may resolve on its own without treatment.”

C. “You will need surgery to repair the lung immediately.”

D. “You must remain on a ventilator for at least 24 hours.”

A

B. “Your condition may resolve on its own without treatment.”

Rationale: In cases of spontaneous pneumothorax, if the patient is stable and the pneumothorax is minimal, it may resolve on its own without the need for invasive treatment. Conservative management and observation are often sufficient.

219
Q

Which early manifestations should the nurse expect in a client with viral myocarditis?

A. Crackles and JVD
B. Fever, fatigue, and myalgias
C. Peripheral edema and syncope
D. Angina and pleuritic chest pain

A

B. Fever, fatigue, and myalgias

Rationale: Early symptoms of viral myocarditis often mimic those of a viral illness and include fever, fatigue, malaise, and myalgias.

220
Q

The nurse auscultates an S3 heart sound in a client with myocarditis. This finding indicates:

A. Progression to heart failure
B. Early infection
C. Resolution of myocarditis
D. Normal cardiac function

A

A. Progression to heart failure

Rationale: An S3 heart sound is a late sign of myocarditis and is associated with the development of heart failure due to impaired ventricular function.

221
Q

Which symptom reported by the client suggests a late-stage manifestation of myocarditis?

A. Nausea and vomiting
B. Pleuritic chest pain
C. Syncope
D. Pharyngitis

A

C. Syncope

Rationale: Syncope is a late manifestation of myocarditis, often related to the development of heart failure or arrhythmias.

222
Q

A nurse is assessing a client with myocarditis. Which finding is most concerning and requires immediate intervention?

A. Fatigue and dyspnea
B. Pleuritic chest pain
C. Lymphadenopathy
D. Peripheral edema and crackles

A

D. Peripheral edema and crackles

223
Q

The nurse understands that early cardiac signs of myocarditis typically appear:

A. 1 to 3 days after infection
B. 7 to 10 days after viral infection
C. 2 weeks after infection
D. At the time of heart failure development

A

B. 7 to 10 days after viral infection

Rationale: Early cardiac manifestations, such as chest pain or arrhythmias, usually develop 7 to 10 days after the onset of a viral infection.

224
Q

Which of the following findings is most consistent with pericardial effusion in a client with myocarditis?

A. Increased urine output
B. Bounding pulses
C. Muffled heart sounds
D. Narrow pulse pressure

A

C. Muffled heart sounds

Rationale: Muffled heart sounds are a common sign of pericardial effusion, which may occur with pericarditis in myocarditis.

225
Q

Which ECG finding is most commonly associated with myocarditis?

A. Diffuse ST-segment changes
B. ST-segment elevation in specific leads
C. Prolonged QT interval
D. Normal sinus rhythm

A

A. Diffuse ST-segment changes

Rationale: Nonspecific ECG changes in myocarditis often reflect pericardial involvement, such as diffuse ST-segment changes.

226
Q

Which laboratory finding is most indicative of inflammation in myocarditis?

A. Elevated cardiac biomarkers
B. Increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels
C. Low white blood cell count
D. Normal viral titers

A

B. Increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels

Rationale: Elevated ESR and CRP indicate systemic inflammation, which is commonly seen in myocarditis.

227
Q

What is the most definitive diagnostic test for myocarditis?

A. Echocardiogram
B. MRI
C. ECG
D. Endomyocardial biopsy

A

D. Endomyocardial biopsy

Rationale: Endomyocardial biopsy provides histologic confirmation of myocarditis, particularly during the first 6 weeks of acute illness.

228
Q

A nurse caring for a client with myocarditis notes an EF of 30%. Which intervention is most appropriate?

A. Administer anticoagulants
B. Increase IV fluid rate
C. Discontinue ACE inhibitors
D. Promote early ambulation

A

A. Administer anticoagulants

Rationale: A low ejection fraction increases the risk of clot formation from blood stasis, making anticoagulation necessary.

229
Q

Why must digoxin be used with caution in myocarditis?

A. It causes significant hypotension.
B. Patients are more sensitive to its adverse effects and potential toxicity.
C. It increases the risk of leukocytosis.
D. It reduces cardiac output in these patients.

A

B. Patients are more sensitive to its adverse effects and potential toxicity.

230
Q

A client with myocarditis is receiving milrinone. The nurse understands that this medication’s primary purpose is to:

A. Increase systemic vascular resistance.
B. Decrease afterload and improve cardiac output.
C. Increase heart rate.
D. Reduce inflammation.

A

B. Decrease afterload and improve cardiac output.

Rationale: Milrinone is used to reduce afterload by decreasing systemic vascular resistance, thereby improving cardiac output.

231
Q

Which supportive measure is most appropriate for a client with severe heart failure secondary to myocarditis?

A. Intraaortic balloon pump therapy
B. Long-term corticosteroid use
C. Encouraging moderate physical activity
D. Increasing sodium intake

A

A. Intraaortic balloon pump therapy

Rationale: Intraaortic balloon pump therapy may be required in severe heart failure to assist with cardiac output.

232
Q

What is the primary goal of using ACE inhibitors in myocarditis?

A. Increase heart rate
B. Reduce myocardial workload and treat heart failure
C. Increase sodium and fluid retention
D. Promote clot formation

A

B. Reduce myocardial workload and treat heart failure

Rationale: ACE inhibitors reduce myocardial workload and improve cardiac output by lowering blood pressure and decreasing afterload.

233
Q

Which client with myocarditis is most likely to benefit from immunosuppressive therapy?

A. A client with bacterial myocarditis

B. A client with mild viral myocarditis

C. A client with normal cardiac function

D. A client with autoimmune myocarditis

A

D. A client with autoimmune myocarditis

Rationale: Immunosuppressive agents are used to reduce heart inflammation and damage in cases of myocarditis with an autoimmune basis.

234
Q

What is the primary benefit of diuretics in the treatment of myocarditis?

A. Increase afterload
B. Decrease myocardial inflammation
C. Reduce fluid volume and preload
D. Lower heart rate

A

C. Reduce fluid volume and preload

Rationale: Diuretics help manage heart failure symptoms by reducing fluid volume and preload, alleviating stress on the heart.

235
Q

The nurse is reviewing medications for a client with myocarditis. Which drug combination requires clarification with the provider?

A. Digoxin and diuretics
B. ACE inhibitors and β-blockers
C. Anticoagulants and immunosuppressive agents
D. Digoxin and nitroprusside

A

D. Digoxin and nitroprusside

Rationale: Caution is required with digoxin due to its potential toxicity. Using it alongside vasodilators like nitroprusside may complicate hemodynamic stability.

236
Q

What is the primary goal of nursing interventions for a patient with myocarditis?

A. Prevent infection and reduce fever

B. Improve cardiac output and manage heart failure symptoms

C. Enhance physical activity and endurance

D. Promote weight gain and nutritional intake

A

B. Improve cardiac output and manage heart failure symptoms

Rationale: Nursing interventions focus on improving cardiac output and addressing symptoms of heart failure to reduce cardiac workload.

237
Q

Which nursing action best helps to decrease the cardiac workload in a patient with myocarditis?

A. Placing the patient in a semi-Fowler’s position
B. Encouraging frequent ambulation
C. Providing a high-sodium diet
D. Increasing IV fluid intake

A

A. Placing the patient in a semi-Fowler’s position

Rationale: The semi-Fowler’s position reduces venous return and pulmonary congestion, decreasing cardiac workload.

238
Q

A patient with myocarditis is receiving immunosuppressive therapy. Which nursing intervention is the highest priority?

A. Assessing for signs of infection
B. Monitoring for cardiac dysrhythmias
C. Evaluating therapeutic drug levels
D. Encouraging ambulation to prevent DVT

A

A. Assessing for signs of infection

Rationale: Immunosuppressive therapy increases infection risk, making infection prevention and monitoring a top priority.

239
Q

A patient with myocarditis is prescribed nitroprusside. What is the nurse’s priority assessment?

A. Monitoring potassium levels
B. Checking for hypotension
C. Assessing for muscle weakness
D. Evaluating fluid intake and output

A

B. Checking for hypotension

Rationale: Nitroprusside is a vasodilator that reduces afterload but may cause significant hypotension, requiring close monitoring.

240
Q

Which patient statement indicates a need for further education about myocarditis recovery?

A. “I will get plenty of rest and avoid overexertion.”
B. “I need to stay on my medications to manage my symptoms.”
C. “Once I feel better, I can return to full activity immediately.”
D. “I will monitor for signs of infection and notify my provider.”

A

C. “Once I feel better, I can return to full activity immediately.”

Rationale: Patients recovering from myocarditis should gradually resume activity and avoid sudden increases in exertion to prevent cardiac stress.

241
Q

A nurse is caring for a client diagnosed with viral myocarditis. Which causative agent is most commonly associated with this condition?

A. Streptococcus pneumonia
B. Coxsackie B virus
C. Candida albicans
D. Epstein-Barr virus

A

B. Coxsackie B virus

Rationale: Coxsackie A and B viruses are the most common causative agents of viral myocarditis. Bacteria, fungi, and other viruses may cause myocarditis but are less common.

242
Q

The nurse understands that which of the following patients is at highest risk for developing myocarditis?

A. A patient with a history of autoimmune disease
B. A patient with controlled hypertension
C. A patient recovering from a hip replacement
D. A patient with a history of peptic ulcer disease

A

A. A patient with a history of autoimmune disease

Rationale: Autoimmune disorders, such as polymyositis, have been linked with the development of myocarditis due to the autoimmune response targeting the myocardium.

243
Q

Which intervention is most appropriate for managing a patient with myocarditis?

A. Administering antibiotics for bacterial causes
B. Encouraging high-intensity exercise to maintain cardiac output
C. Providing supportive care to reduce myocardial workload
D. Administering anticoagulants to prevent clot formation

A

C. Providing supportive care to reduce myocardial workload

Rationale: Treatment for myocarditis focuses on supportive care, such as reducing myocardial workload, improving cardiac function, and managing complications like heart failure.

244
Q

A client with myocarditis asks why they are experiencing heart dysfunction. The nurse explains that this is due to:

A. Fluid overload from heart failure
B. Direct cellular invasion and immune-mediated destruction
C. Decreased oxygen supply to the coronary arteries
D. Scarring and calcification of the myocardium

A

B. Direct cellular invasion and immune-mediated destruction

Rationale: Myocarditis involves cellular damage caused by infectious agents and the immune system, leading to myocardial dysfunction.

245
Q

What complication is most likely to develop in a client with myocarditis?

A. Cardiomyopathy
B. Deep vein thrombosis
C. Pulmonary embolism
D. Chronic obstructive pulmonary disease

A

A. Cardiomyopathy

Rationale: Myocarditis can lead to cardiomyopathy due to the inflammatory process causing structural and functional abnormalities in the heart muscle.

246
Q

A nurse is assessing a patient with suspected myocarditis. Which symptom is most commonly associated with this condition?

A. Peripheral edema
B. Pleuritic chest pain
C. Bradycardia
D. Fatigue and dyspnea

A

D. Fatigue and dyspnea

Rationale: Fatigue and dyspnea are common symptoms of myocarditis, often resulting from the heart’s reduced ability to pump effectively. While pleuritic chest pain may occur, it is less frequent. Peripheral edema and bradycardia are not hallmark symptoms of myocarditis.

247
Q

What is the primary treatment goal for a patient diagnosed with myocarditis?

A. Relieve chest pain
B. Prevent progression to heart failure
C. Treat bacterial infection
D. Increase heart rate

A

B. Prevent progression to heart failure

Rationale: The primary treatment goal for myocarditis is to prevent heart failure by supporting cardiac function and reducing myocardial inflammation.

248
Q

A patient with myocarditis is prescribed an ACE inhibitor. What is the purpose of this medication in treating myocarditis?

A. To reduce myocardial inflammation
B. To improve cardiac output by decreasing afterload
C. To treat the underlying infection
D. To prevent arrhythmias

A

B. To improve cardiac output by decreasing afterload

Rationale: ACE inhibitors decrease afterload, improving cardiac output and reducing stress on the heart, which is crucial in managing myocarditis-related heart dysfunction.

249
Q

What is the most common cause of myocarditis worldwide?

A. Bacterial infections
B. Fungal infections
C. Autoimmune diseases
D. Viral infections

A

D. Viral infections

Rationale: Viral infections, particularly Coxsackievirus B, are the most common cause of myocarditis worldwide.

250
Q

A patient with myocarditis reports worsening shortness of breath and orthopnea. What is the nurse’s priority intervention?

A. Administer a diuretic as prescribed
B. Encourage bedrest to decrease cardiac workload
C. Notify the healthcare provider immediately
D. Obtain a 12-lead ECG

A

C. Notify the healthcare provider immediately

Rationale: Worsening symptoms such as shortness of breath and orthopnea may indicate heart failure or a life-threatening complication. Immediate provider notification is critical.

251
Q

Which medication is contraindicated in a patient with myocarditis due to the risk of worsening myocardial damage?

A. NSAIDs
B. Beta-blockers
C. Diuretics
D. Corticosteroids

A

A. NSAIDs

Rationale: NSAIDs are contraindicated in myocarditis as they may increase myocardial damage and interfere with healing by promoting inflammation.

252
Q

A nurse is assessing a patient with suspected acute pericarditis. Which clinical manifestation should the nurse expect to find?

A. Pericardial friction rub
B. Crackles in the lungs
C. Pulsus paradoxus
D. Systolic murmur

A

A. Pericardial friction rub

Rationale: A pericardial friction rub is a hallmark sign of pericarditis, caused by the inflamed pericardial layers rubbing against each other. Crackles in the lungs are associated with pulmonary conditions, pulsus paradoxus is more common in cardiac tamponade, and a systolic murmur is associated with valve disorders.

253
Q

A patient with acute pericarditis reports sharp chest pain that worsens when lying flat. What intervention should the nurse recommend to alleviate this symptom?

A. Administer a beta-blocker
B. Encourage the patient to sit upright and lean forward
C. Provide a warm compress to the chest
D. Restrict oral fluid intake

A

B. Encourage the patient to sit upright and lean forward

Rationale: Sitting upright and leaning forward reduces pressure on the pericardium, decreasing pain. Beta-blockers are not indicated for symptom relief in pericarditis. Warm compresses and fluid restrictions are unrelated to managing the pain associated with pericarditis.

254
Q

Which diagnostic test result is most indicative of acute pericarditis?

A. ST-segment elevation in all ECG leads
B. Low ejection fraction on echocardiogram
C. Elevated troponin levels
D. Decreased white blood cell count

A

A. ST-segment elevation in all ECG leads

Rationale: Diffuse ST-segment elevation is a characteristic finding in acute pericarditis. Low ejection fraction is not typically associated with pericarditis. Elevated troponin levels suggest myocardial injury, and a decreased WBC count is not associated with inflammation.

255
Q

A nurse is preparing to discharge a patient diagnosed with acute pericarditis. Which statement by the patient indicates a need for further teaching?

A. “I should avoid strenuous activity until cleared by my doctor.”

B. “I will take my NSAIDs as prescribed to reduce inflammation.”

C. “If I have trouble breathing or feel faint, I should rest and wait for the symptoms to resolve.”

D. “I need to follow up with my healthcare provider regularly.”

A

C. “If I have trouble breathing or feel faint, I should rest and wait for the symptoms to resolve.”

Rationale: Trouble breathing or feeling faint may indicate complications such as cardiac tamponade, which requires immediate medical attention. This statement reflects a misunderstanding of the seriousness of these symptoms. The other statements demonstrate accurate understanding.

256
Q

Which statement best describes the pathophysiology of acute pericarditis?

A. Rapid bacterial invasion leads to sepsis and necrosis of pericardial tissue.

B. Inflammation of the pericardial sac results in neutrophil influx and fibrin deposition.

C. Chronic immune activation causes myocardial fibrosis.

D. Coronary artery occlusion leads to ischemic pericardial damage.

A

B. Inflammation of the pericardial sac results in neutrophil influx and fibrin deposition.

Rationale: Acute pericarditis is characterized by an inflammatory process in the pericardial sac, resulting in neutrophil infiltration, increased vascularity, and fibrin deposition. This response may lead to pericardial effusion.

257
Q

A nurse is assessing a patient with suspected acute pericarditis. Which of the following symptoms would most likely confirm the diagnosis?

A. Progressive, sharp chest pain that worsens with lying flat

B. Dull chest pain radiating to the jaw and associated with exertion

C. Chest pain that improves with nitroglycerin administration

D. Sudden, crushing chest pain that resolves with rest

A

A. Progressive, sharp chest pain that worsens with lying flat

Rationale: Acute pericarditis typically presents with sharp, pleuritic chest pain that worsens with lying flat and improves when sitting up and leaning forward. This pain may radiate to the neck, arms, or shoulder but is distinct from angina or myocardial infarction.

258
Q

The nurse auscultates a high-pitched, scratching sound at the lower left sternal border of a patient suspected of having acute pericarditis. Which action should the nurse take to confirm that this is a pericardial friction rub?

A. Ask the patient to hold their breath and listen for the sound.

B. Reassess the sound while the patient is lying flat.

C. Have the patient cough to see if the sound resolves.

D. Observe for changes in the sound during inspiration and expiration.

A

A. Ask the patient to hold their breath and listen for the sound.

Rationale: A pericardial friction rub persists when the patient holds their breath, distinguishing it from a pleural friction rub, which disappears when the patient stops breathing.

259
Q

A patient reports chest pain that radiates to the trapezius muscle and worsens with deep breathing. Which condition does the nurse suspect?

A. Stable angina
B. Acute pericarditis
C. Pulmonary embolism
D. Gastroesophageal reflux disease (GERD)

A

B. Acute pericarditis

Rationale: Chest pain radiating to the trapezius muscle (shoulder and upper back) is a distinguishing feature of acute pericarditis. This pain is often worsened by deep inspiration and lying flat.

260
Q

A patient with acute pericarditis is experiencing dyspnea. What is the most likely cause of this symptom?

A. Decreased cardiac output from pericardial effusion

B. Compression of the airway by the inflamed pericardium

C. Pulmonary congestion due to left-sided heart failure

D. Rapid, shallow breathing to avoid chest pain

A

D. Rapid, shallow breathing to avoid chest pain

Rationale: Patients with acute pericarditis often breathe in rapid, shallow breaths to minimize movement of the chest wall and reduce pain caused by pericardial inflammation.

261
Q

The nurse is assessing a patient with chest pain caused by acute pericarditis. Which patient position will most likely relieve the pain?

A. Lying on the left side
B. Supine with knees elevated
C. Sitting up and leaning forward
D. Standing with arms crossed

A

C. Sitting up and leaning forward

Rationale: Sitting up and leaning forward reduces pressure on the pericardium and alleviates chest pain caused by acute pericarditis. Pain typically worsens when lying flat.

262
Q

A patient with acute pericarditis reports progressive, severe chest pain. Which characteristic best differentiates this pain from angina?

A. Pain radiating to the trapezius muscle

B. Pain that improves with rest

C. Pain described as dull and aching

D. Pain that worsens with physical exertion

A

A. Pain radiating to the trapezius muscle

Rationale: Pain radiating to the trapezius muscle (shoulder or upper back) is specific to pericarditis and helps differentiate it from angina. Angina typically presents with dull, aching pain that resolves with rest.

263
Q

The nurse is auscultating a patient with acute pericarditis. The pericardial friction rub is most likely to be heard during which phase of the cardiac cycle?

A. Systole only
B. Diastole only
C. Early systole
D. Both systole and diastole

A

D. Both systole and diastole

Rationale: A pericardial friction rub is typically heard during both systole and diastole due to friction between the inflamed pericardial layers.

264
Q

Which diagnostic imaging study is most useful in identifying pericardial effusion or cardiac tamponade?

A. Echocardiogram
B. Chest x-ray
C. CT scan
D. MRI

A

A. Echocardiogram

Rationale: An echocardiogram is the primary diagnostic tool to detect pericardial effusion or cardiac tamponade, as it provides a clear view of the pericardial space and heart function.

265
Q

Which laboratory finding is commonly associated with acute pericarditis?

A. Decreased CRP
B. Increased ESR
C. Decreased leukocyte count
D. Normal troponin levels

A

B. Increased ESR

Rationale: Elevated CRP and ESR are common inflammatory markers found in acute pericarditis. Leukocytosis may also be present.

266
Q

A chest x-ray of a patient with acute pericarditis is most likely to reveal:

A. Cardiomegaly in all cases

B. Diffuse calcifications of the pericardium

C. Enlarged pulmonary vessels

D. A large pericardial effusion as cardiomegaly

A

D. A large pericardial effusion as cardiomegaly

Rationale: In acute pericarditis, a chest x-ray is typically normal unless a large pericardial effusion is present, which can appear as cardiomegaly.

267
Q

A CT scan or MRI is preferred over an echocardiogram in acute pericarditis for which purpose?

A. Visualizing localized myocardial ischemia
B. Diagnosing pericardial effusion
C. Visualizing the pericardium and pericardial space
D. Diagnosing coronary artery blockages

A

C. Visualizing the pericardium and pericardial space

Rationale: CT scans and MRIs provide detailed images of the pericardium and pericardial space, making them useful for diagnosing structural abnormalities.

268
Q

Which medication is most appropriate for a patient with acute pericarditis due to systemic lupus erythematosus?

A. NSAIDs
B. Colchicine
C. Antibiotics
D. Corticosteroids

A

D. Corticosteroids

Rationale: Corticosteroids are indicated for patients with pericarditis caused by systemic lupus erythematosus or other autoimmune conditions when NSAIDs are ineffective.

269
Q

What is the primary purpose of pericardiocentesis in acute cardiac tamponade?

A. Prevent recurrent effusion
B. Administer medication directly to the pericardial space
C. Remove fluid to relieve heart pressure
D. Correct dysrhythmias

A

C. Remove fluid to relieve heart pressure

Rationale: Pericardiocentesis removes excess fluid from the pericardial sac to relieve pressure on the heart, improving cardiac output and hemodynamics.

270
Q

Colchicine is most useful in managing:

A. Recurrent pericarditis or pericarditis lasting more than 10 days
B. Bacterial pericarditis
C. Acute pericarditis with ST elevation
D. Pericarditis caused by trauma

A

A. Recurrent pericarditis or pericarditis lasting more than 10 days

Rationale: Colchicine is an anti-inflammatory medication beneficial in managing recurrent or persistent pericarditis due to its ability to reduce inflammation.

271
Q

A patient with acute pericarditis reports severe, sharp chest pain that worsens when lying flat. Which intervention should the nurse implement first?

A. Administer prescribed anti-inflammatory medication.
B. Assist the patient into a sitting position, leaning forward.
C. Provide a proton pump inhibitor to prevent GI discomfort.
D. Explain the cause of the chest pain to the patient.

A

B. Assist the patient into a sitting position, leaning forward.

Rationale: Sitting up and leaning forward can help relieve chest pain associated with acute pericarditis. This intervention provides immediate comfort before other measures are implemented.

272
Q

Which nursing intervention is the priority for a patient at risk for cardiac tamponade?

A. Position the patient flat in bed to monitor for dyspnea.

B. Administer anti-inflammatory medications to reduce inflammation.

C. Monitor for muffled heart sounds, neck vein distention, and pulsus paradoxes.

D. Prepare the patient for a chest x-ray to confirm the diagnosis.

A

C. Monitor for muffled heart sounds, neck vein distention, and pulsus paradoxes.

Rationale: These are key signs of cardiac tamponade, a life-threatening complication. Prompt recognition allows timely intervention.

273
Q

When managing a patient with acute pericarditis, the nurse should place the patient in which position to provide the greatest comfort?

A. Supine with the head of the bed flat
B. Semi-Fowler’s position with knees flexed
C. Left side-lying with legs elevated
D. Sitting upright with the bed at 45 degrees

A

D. Sitting upright with the bed at 45 degrees

Rationale: This position helps relieve the sharp chest pain by reducing pressure on the pericardium.

274
Q

A patient with acute pericarditis is prescribed a proton pump inhibitor (PPI). What is the primary reason for this prescription?

A. To prevent GI discomfort associated with NSAID use

B. To reduce inflammation in the pericardium

C. To treat esophageal reflux caused by lying flat

D. To manage anxiety related to chest pain

A

A. To prevent GI discomfort associated with NSAID use

Rationale: PPIs reduce stomach acid, preventing GI irritation and potential ulcers caused by NSAIDs.

275
Q

The nurse is assessing a patient with acute pericarditis and suspects cardiac tamponade. Which clinical finding supports this suspicion?

A. Widened pulse pressure
B. Loud, bounding heart sounds
C. Jugular vein distention and muffled heart sounds
D. Chest pain relieved by leaning forward

A

C. Jugular vein distention and muffled heart sounds

Rationale: Jugular vein distention, muffled heart sounds, and pulsus paradoxus are hallmark signs of cardiac tamponade, requiring immediate intervention.

276
Q

A patient is diagnosed with acute pericarditis. Which statement by the nurse accurately explains this condition?

A. “Pericarditis involves inflammation of the sac surrounding the heart.”
B. “Pericarditis is an infection of the inner lining of the heart valves.”
C. “Pericarditis results from thickening of the heart muscle walls.”
D. “Pericarditis is a genetic condition affecting the heart chambers.”

A

A. “Pericarditis involves inflammation of the sac surrounding the heart.”

Rationale: Pericarditis is the inflammation of the pericardium, the sac that encases the heart.

277
Q

Which clinical finding is most indicative of acute pericarditis?

A. Crushing chest pain radiating to the jaw

B. Chest pain relieved by sitting up and leaning forward

C. Irregular heart rhythms on ECG

D. Dependent edema and ascites

A

B. Chest pain relieved by sitting up and leaning forward

Rationale: Acute pericarditis typically presents with pleuritic chest pain that improves with sitting up or leaning forward, differentiating it from myocardial infarction pain.

278
Q

Which medication is most commonly prescribed for managing inflammation in acute pericarditis?

A. Furosemide
B. Prednisone
C. Ibuprofen
D. Amiodarone

A

C. Ibuprofen

Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are the first-line treatment to reduce inflammation and relieve pain in pericarditis.

279
Q

Which of the following is an expected outcome for a patient recovering from pericarditis?

A. Resolution of pericardial friction rub within 48 hours
B. Ability to resume strenuous exercise immediately
C. Decreased peripheral edema
D. Absence of chest pain at rest

A

D. Absence of chest pain at rest

Rationale: An expected outcome is the resolution of pain at rest, indicating reduced inflammation and healing.

280
Q

Which diagnostic finding is considered a major criterion for infective endocarditis (IE) according to the Duke Criteria?

a. Mild leukocytosis
b. Positive blood cultures from two separate sites
c. Presence of Janeway’s lesions
d. Increased erythrocyte sedimentation rate (ESR)

A

b. Positive blood cultures from two separate sites

Rationale: Positive blood cultures for a typical microorganism are a major Duke Criterion for diagnosing IE. The other findings are minor criteria or nonspecific.

281
Q

A patient with suspected infective endocarditis (IE) has received antibiotics for a skin infection in the past 2 weeks. What diagnostic challenge might this pose?

a. Negative blood cultures despite active infection
b. False-positive echocardiographic findings
c. Decreased C-reactive protein (CRP) levels
d. Absence of leukocytosis

A

a. Negative blood cultures despite active infection

Rationale: Recent antibiotic use can lead to culture-negative IE, as it may suppress bacterial growth in blood cultures.

282
Q

Which minor criterion in the Duke Criteria is most likely to be documented in a patient with a history of IV drug use?

a. Vascular phenomena
b. Immunologic phenomena
c. Predisposing heart condition or IV drug use
d. Echocardiographic findings

A

c. Predisposing heart condition or IV drug use

Rationale: A history of IV drug use is a recognized minor criterion for IE, as it increases the risk of infection.

283
Q

Why is echocardiography crucial in the diagnosis of infective endocarditis (IE)?

a. It identifies the microorganism causing the infection.
b. It confirms the presence of vegetations on the valves.
c. It rules out culture-negative IE.
d. It detects changes in C-reactive protein levels.

A

b. It confirms the presence of vegetations on the valves.

Rationale: Echocardiography (especially transesophageal) is essential for visualizing vegetations, which is a key diagnostic feature of IE.

284
Q

Which laboratory finding supports the diagnosis of acute IE?

a. Mild leukocytosis
b. Normal ESR and CRP levels
c. Negative blood cultures
d. Decreased platelet count

A

a. Mild leukocytosis

Rationale: Mild leukocytosis is a common finding in acute IE due to the systemic inflammatory response.

285
Q

Which combination of criteria confirms a diagnosis of IE according to the Duke Criteria?

a. One major and one minor criterion
b. Two major criteria and one minor criterion
c. Five minor criteria
d. Either b or c

A

d. Either b or c

286
Q

A 35-year-old IV drug user presents with fever, fatigue, and a new-onset heart murmur. Blood cultures confirm the presence of Staphylococcus aureus. Which of the following is a major Duke criterion for diagnosing infective endocarditis?

A. Positive blood cultures for Staphylococcus aureus
B. Presence of Janeway lesions
C. Fever >38°C (100.4°F)
D. Splinter hemorrhages

A

A. Positive blood cultures for Staphylococcus aureus

Rationale: Positive blood cultures for typical microorganisms, such as Staphylococcus aureus, are a major Duke criterion. The other options are minor criteria or clinical findings associated with infective endocarditis.

287
Q

A nurse is reviewing the diagnostic criteria for infective endocarditis. Which of the following echocardiographic findings meets a major Duke criterion?

A. Vegetation on a prosthetic valve
B. Pericardial effusion
C. Left ventricular hypertrophy
D. Atrial septal defect

A

A. Vegetation on a prosthetic valve

Rationale: The presence of vegetation on a valve or prosthetic valve is a major Duke criterion. The other findings are not diagnostic features of infective endocarditis

288
Q

A patient with a history of mitral valve prolapse is diagnosed with infective endocarditis caused by Staphylococcus aureus. Which of the following symptoms is classified as a major Duke criterion?

A. Roth spots
B. Osler nodes
C. Positive echocardiogram showing valvular regurgitation
D. Arthralgia

A

C. Positive echocardiogram showing valvular regurgitation

Rationale: Evidence of valvular dysfunction, such as regurgitation on echocardiography, is a major criterion. Roth spots and Osler nodes are minor criteria.

289
Q

Which of the following patients is at the highest risk of developing infective endocarditis caused by Staphylococcus aureus?

A. A 25-year-old with rheumatic heart disease
B. A 40-year-old with a prosthetic heart valve
C. A 30-year-old IV drug user
D. A 65-year-old with uncontrolled hypertension

A

C. A 30-year-old IV drug user

Rationale: IV drug use is a significant risk factor for infective endocarditis caused by Staphylococcus aureus. Prosthetic heart valves increase risk but are less specific for this organism.

290
Q

A patient diagnosed with infective endocarditis has persistent bacteremia after appropriate antibiotic therapy for Staphylococcus aureus. What is the next best action?

A. Continue current antibiotics
B. Add antifungal therapy
C. Initiate corticosteroids
D. Evaluate for valvular abscess

A

D. Evaluate for valvular abscess

Rationale: Persistent bacteremia despite therapy suggests a complication such as a valvular abscess, which must be evaluated and treated promptly.

291
Q

Which of the following best defines a pulmonary embolism (PE)?

A. An infection of the lung tissue caused by bacteria.
B. An obstruction of a pulmonary artery by a blood clot, fat, or air embolism.
C. The collapse of alveoli due to lack of surfactant.
D. A collection of fluid in the pleural space.

A

B. An obstruction of a pulmonary artery by a blood clot, fat, or air embolism.

Rationale: A PE occurs when a substance (commonly a blood clot) blocks blood flow in a pulmonary artery, reducing oxygenation and leading to respiratory distress.

292
Q

Which of the following is the most common cause of pulmonary embolism?

A. Air embolism.
B. Fat embolism.
C. Deep vein thrombosis (DVT).
D. Foreign body aspiration.

A

C. Deep vein thrombosis (DVT).

Rationale: DVT is the most frequent cause of PE. Clots formed in the deep veins of the legs travel through the bloodstream to the pulmonary arteries.

293
Q

Which patient is at the highest risk for developing a pulmonary embolism?

A. A 35-year-old marathon runner.
B. A 50-year-old smoker with a history of hypertension.
C. A 70-year-old patient on prolonged bed rest after hip surgery.
D. A 25-year-old with a history of asthma.

A

C. A 70-year-old patient on prolonged bed rest after hip surgery.

Rationale: Prolonged immobility, surgery, and advanced age significantly increase the risk of venous stasis and DVT, which can lead to PE.

294
Q

Which of the following is the most common clinical manifestation of a pulmonary embolism?

A. Sudden onset of dyspnea and chest pain.
B. Wheezing.
C. Productive cough with green sputum.
D. Hyperactive bowel sounds.

A

A. Sudden onset of dyspnea and chest pain.

Rationale: Dyspnea and chest pain are hallmark symptoms of PE due to the sudden obstruction of blood flow in the lungs.

295
Q

A patient presents with tachypnea, tachycardia, and sudden onset of pleuritic chest pain. What should the nurse assess for next?

A. Lung auscultation for crackles.
B. Assessment of peripheral pulses.
C. Signs of lower extremity swelling and redness.
D. Evaluation of bowel sounds.

A

C. Signs of lower extremity swelling and redness.

Rationale: Assessing for signs of DVT (e.g., swelling, redness) can help identify the source of the embolism.

296
Q

Which diagnostic test is most specific for confirming the presence of a pulmonary embolism?

A. Chest X-ray.
B. D-dimer assay.
C. Pulmonary function tests (PFTs).
D. Spiral computed tomography (CT) scan with contrast.

A

D. Spiral computed tomography (CT) scan with contrast.

Rationale: A spiral CT scan provides direct visualization of the pulmonary vasculature, making it the gold standard for diagnosing PE.

297
Q

A D-dimer test is ordered for a patient suspected of having a pulmonary embolism. What does an elevated D-dimer indicate?

A. Infection is present.
B. Significant clot breakdown is occurring in the body.
C. Lung tissue is inflamed.
D. There is no clot present.

A

B. Significant clot breakdown is occurring in the body.

Rationale: An elevated D-dimer indicates fibrin degradation products, suggesting the presence of a thrombotic event, but it is not specific to PE.

298
Q

A patient with PE is prescribed IV heparin. What is the primary goal of this therapy?

A. To dissolve the clot.
B. To prevent the formation of new clots.
C. To improve oxygenation.
D. To lower blood pressure.

A

B. To prevent the formation of new clots.

Rationale: Heparin prevents further clot formation and stabilizes the existing clot, reducing the risk of additional emboli.

299
Q

Which of the following complications is most life-threatening in a patient with PE?

A. Acute respiratory distress syndrome (ARDS).
B. Chronic obstructive pulmonary disease (COPD).
C. Pulmonary hypertension.
D. Right ventricular failure.

A

D. Right ventricular failure.

Rationale: A PE increases right heart strain, potentially causing acute right ventricular failure, which can lead to hemodynamic collapse.

300
Q

A patient with PE suddenly becomes hypotensive and cyanotic. What should the nurse suspect?

A. Myocardial infarction.
B. Acute massive pulmonary embolism.
C. Pleural effusion.
D. Pneumothorax.

A

B. Acute massive pulmonary embolism.

Rationale: Massive PE causes obstruction of pulmonary blood flow, leading to decreased cardiac output and shock.

301
Q

A patient with PE is prescribed warfarin. Which lab value is most important for the nurse to monitor?

A. Platelet count.
B. Partial thromboplastin time (PTT).
C. Prothrombin time (PT) and INR.
D. D-dimer levels.

A

C. Prothrombin time (PT) and INR.

Rationale: PT/INR monitors warfarin’s therapeutic effect to ensure anticoagulation while minimizing bleeding risk.

302
Q

What is the most common source of a pulmonary embolism (PE)?

A) Fat embolism from fractured long bones
B) Deep vein thrombosis (DVT) from the deep veins of the legs
C) Air embolism from improperly administered IV therapy
D) Amniotic fluid embolism

A

B) Deep vein thrombosis (DVT) from the deep veins of the legs

Rationale: The majority of pulmonary embolisms originate from deep vein thrombosis (DVT) in the deep veins of the legs. Other sources are less common.

303
Q

Which of the following is a risk factor for pulmonary embolism (PE)? (Select all that apply)

A) History of deep vein thrombosis (DVT)
B) Pregnancy
C) Recent hip surgery
D) Use of oral contraceptives
E) Smoking

A

all of the choices are correct

304
Q

What is a “saddle embolus”?

A) A large thrombus lodged at the arterial bifurcation
B) A small thrombus located in the pulmonary veins
C) A fat embolism from a fractured long bone
D) An air embolism from improper IV therapy

A

A) A large thrombus lodged at the arterial bifurcation

Rationale: A saddle embolus refers to a large thrombus that becomes lodged at the bifurcation of a pulmonary artery, potentially obstructing blood flow to both lungs.

305
Q

Which of the following is the most likely consequence of a pulmonary embolism (PE)?

A) Increased blood flow to the alveoli
B) Obstruction of perfusion to the alveoli
C) Decreased cardiac output
D) Elevated blood pressure in the lungs

A

B) Obstruction of perfusion to the alveoli

Rationale: A pulmonary embolism causes a blockage of pulmonary arteries, obstructing the blood flow to the alveoli and impairing oxygen exchange.

306
Q

A patient with a history of pelvic surgery presents with sudden chest pain and shortness of breath. Which of the following is the priority assessment?

A) Auscultate lung sounds
B) Check for signs of deep vein thrombosis (DVT)
C) Administer pain medication
D) Assess for signs of a stroke

A

A) Auscultate lung sounds

Rationale: A patient presenting with sudden chest pain and shortness of breath may have a pulmonary embolism. Auscultation of lung sounds is a priority to assess for abnormal lung sounds like crackles or decreased breath sounds.

307
Q

Which of the following describes the pathophysiology of pulmonary embolism (PE)?

A) An embolus travels through the pulmonary arteries and obstructs alveolar perfusion

B) A thrombus forms in the pulmonary veins and blocks gas exchange

C) An embolus travels through the left side of the heart and obstructs systemic circulation

D) Fat cells from fractured long bones enter the lungs and obstruct airflow

A

A) An embolus travels through the pulmonary arteries and obstructs alveolar perfusion

Rationale: The embolus travels through the venous system to the pulmonary circulation, where it lodges in a pulmonary artery, blocking perfusion to the alveoli.

308
Q

Which of the following is the most appropriate intervention for a patient suspected of having a pulmonary embolism (PE)?

A) Encourage deep breathing exercises
B) Provide high-flow oxygen therapy
C) Start IV fluids at a rapid rate
D) Administer anticoagulant therapy as prescribed

A

D) Administer anticoagulant therapy as prescribed

Rationale: Anticoagulant therapy is a primary intervention to prevent further clot formation and reduce the risk of complications from a PE.

309
Q

Which of the following is the most commonly used diagnostic test for confirming pulmonary embolism (PE)?

A) Chest x-ray
B) Venous ultrasound
C) Spiral CT scan (CT angiography)
D) D-dimer test

A

C) Spiral CT scan (CT angiography)

Rationale: The spiral CT scan, or CT angiography, is the most common and accurate diagnostic test for confirming pulmonary embolism.

310
Q

A patient presents with symptoms of pulmonary embolism (PE). Which diagnostic test is typically used if the patient cannot receive contrast media for a spiral CT scan?

A) Ventilation-perfusion (V/Q) scan
B) Chest x-ray
C) Pulmonary angiography
D) Serum troponin test

A

A) Ventilation-perfusion (V/Q) scan

Rationale: If a patient cannot receive contrast media for a CT scan, a ventilation-perfusion (V/Q) scan is used to diagnose PE by assessing lung ventilation and blood flow.

311
Q

Which of the following is a limitation of using the D-dimer test for diagnosing pulmonary embolism (PE)?

A) It is highly specific for PE.
B) It may be falsely negative in patients with large PE.
C) It is not sensitive enough to detect a small PE.
D) It is not useful in patients with cancer.

A

C) It is not sensitive enough to detect a small PE.

Rationale: D-dimer is not sensitive enough to detect small PEs, as up to 50% of patients with small PE may have a normal D-dimer result.

312
Q

What does an elevated serum troponin level in a patient with pulmonary embolism (PE) typically indicate?

A) Right ventricular strain or injury
B) Renal insufficiency
C) Myocardial infarction
D) Pulmonary hypertension

A

A) Right ventricular strain or injury

Rationale: Elevated serum troponin levels in a patient with PE indicate right ventricular strain or injury due to increased pressure from the obstruction in the pulmonary circulation.

313
Q

Which of the following is the primary purpose of using a ventilation-perfusion (V/Q) scan in the diagnosis of pulmonary embolism (PE)?

A) To confirm the presence of an embolus in the pulmonary circulation
B) To assess lung tissue damage
C) To identify pre-existing lung disease
D) To evaluate pulmonary blood flow and ventilation distribution

A

D) To evaluate pulmonary blood flow and ventilation distribution

Rationale: A V/Q scan evaluates both the blood flow (perfusion) and ventilation in the lungs to help identify areas of mismatch, which may indicate a PE.

314
Q

A patient with a suspected pulmonary embolism (PE) is being assessed. Which of the following findings is most likely to be seen on a chest x-ray?

A) Hemoptysis
B) Atelectasis or pleural effusion
C) Enlargement of the heart
D) Pulmonary consolidation

A

B) Atelectasis or pleural effusion

Rationale: Chest x-rays may show atelectasis or pleural effusion, but these findings are not diagnostic for PE and may be seen in a variety of other conditions.

315
Q

A patient with a pulmonary embolism (PE) is experiencing pain from pleural irritation. Which medication should be administered to manage this pain?

A) Acetaminophen
B) Anticoagulants
C) Aspirin
D) Opioids

A

D) Opioids

Rationale: Opioids are used to manage pain associated with pleural irritation or reduced coronary blood flow in patients with PE.

316
Q

A patient with suspected pulmonary embolism (PE) is showing signs of shock. What is the most appropriate action to support circulation immediately?

A) Administer IV fluids and vasopressor agents
B) Administer oxygen therapy
C) Start heparin therapy
D) Provide mechanical ventilation

A

A) Administer IV fluids and vasopressor agents

Rationale: In the presence of shock, IV fluids and vasopressors are used to support circulation and stabilize the patient’s hemodynamic status.

317
Q

What is the goal of interprofessional care when treating a patient with a pulmonary embolism (PE)?

A) To reduce pain and prevent atelectasis
B) To perform early surgery for thrombus removal
C) To prevent further thrombus growth and recurrence
D) To administer antibiotics for infection prevention

A

C) To prevent further thrombus growth and recurrence

Rationale: The primary goals in treating PE are to prevent further thrombus growth, recurrence, and complications, while maintaining adequate oxygenation and circulation.

318
Q

A patient with pulmonary embolism (PE) is being assessed for mechanical ventilation. In which of the following situations is mechanical ventilation most likely required?

A) If the patient experiences hyperventilation
B) If the patient’s oxygen levels cannot be maintained with a mask or cannula
C) If the patient exhibits signs of deep vein thrombosis (DVT)
D) If the patient develops a fever

A

B) If the patient’s oxygen levels cannot be maintained with a mask or cannula

Rationale: Mechanical ventilation is needed when a patient cannot maintain adequate oxygenation despite the use of a mask or cannula.

319
Q

A patient with a suspected pulmonary embolism (PE) is receiving respiratory support. Which of the following interventions should be prioritized to help prevent atelectasis?

A) Administering opioid pain medications
B) Starting anticoagulation therapy
C) Increasing fluid intake
D) Initiating incentive spirometry and deep breathing exercises

A

D) Initiating incentive spirometry and deep breathing exercises

Rationale: Incentive spirometry, turning, and deep breathing exercises are key interventions to help prevent atelectasis in patients with PE.

320
Q

Which medication is the first-line treatment for a patient with acute pulmonary embolism (PE)?

A) Warfarin (Coumadin)
B) Subcutaneous low-molecular-weight heparin (LMWH)
C) Unfractionated IV heparin
D) Direct thrombin inhibitors

A

B) Subcutaneous low-molecular-weight heparin (LMWH)

Rationale: LMWH is recommended for initial treatment of acute PE because it is safer and more effective than unfractionated heparin and does not require aPTT monitoring.

321
Q

Which laboratory test is required to monitor the effectiveness of unfractionated IV heparin therapy in a patient with PE?

A) Activated Partial Thromboplastin Time (aPTT)
B) International Normalized Ratio (INR)
C) D-dimer
D) Platelet count

A

A) Activated Partial Thromboplastin Time (aPTT)

322
Q

Which patient is most likely to benefit from a pulmonary embolectomy?

A) A patient with a recurrent PE despite anticoagulation
B) A patient with a small PE and mild hypoxemia
C) A patient with a massive PE and hemodynamic instability who cannot receive thrombolytic therapy
D) A patient with an elevated D-dimer but no confirmed PE

A

C) A patient with a massive PE and hemodynamic instability who cannot receive thrombolytic therapy

Rationale: Pulmonary embolectomy is reserved for patients with massive PE and hemodynamic instability who cannot tolerate thrombolytic therapy, as it can rapidly remove emboli and reduce right ventricular afterload.

323
Q

Which intervention is most appropriate for a patient with contraindications to anticoagulation therapy and a high risk for pulmonary embolism?

A) Thrombolytic therapy
B) Inferior vena cava (IVC) filter placement
C) Surgical embolectomy
D) Long-term oxygen therapy

A

B) Inferior vena cava (IVC) filter placement

Rationale: An IVC filter is the treatment of choice for patients at high risk for PE who cannot tolerate anticoagulation, as it prevents large clots from reaching the lungs.

324
Q

What is the primary goal of ultrasound-guided catheter thrombolysis in treating pulmonary embolism?

A) To mechanically remove emboli from the pulmonary arteries
B) To dissolve clots using localized thrombolytic therapy
C) To prevent clot migration to the lungs
D) To avoid the need for anticoagulation therapy

A

B) To dissolve clots using localized thrombolytic therapy

Rationale: Ultrasound-guided catheter thrombolysis delivers thrombolytic agents directly to the clot, aiding in clot dissolution and minimizing systemic effects.

325
Q

A nurse is assessing a patient with pulmonary edema caused by left-sided heart failure. Which of the following clinical manifestations is most commonly associated with this condition?

A. Frothy, blood-tinged sputum
B. Decreased respiratory rate and shallow breathing
C. Bradycardia and hypotension
D. Decreased jugular vein distention

A

A. Frothy, blood-tinged sputum

Rationale: Frothy, blood-tinged sputum is a hallmark sign of pulmonary edema, especially in patients with left-sided heart failure, due to fluid leakage into the alveoli.

326
Q

A nurse is administering diuretics to a patient with pulmonary edema. Which of the following is the primary purpose of this intervention?

A. To increase fluid retention
B. To increase cardiac output
C. To reduce afterload by dilating blood vessels
D. To reduce preload by removing excess fluid

A

D. To reduce preload by removing excess fluid

Rationale: Diuretics, such as furosemide, reduce preload by promoting fluid excretion, which decreases the volume of blood returning to the heart and reduces pulmonary congestion.

327
Q

A patient with pulmonary edema is receiving IV morphine. What is the primary reason for administering this medication?

A. To increase cardiac output
B. To reduce afterload and alleviate dyspnea
C. To promote diuresis
D. To reduce the risk of infection

A

B. To reduce afterload and alleviate dyspnea

Rationale: Morphine is used to reduce afterload and alleviate dyspnea in patients with pulmonary edema by causing vasodilation, which lowers systemic vascular resistance and decreases the work of the heart.

328
Q

A patient with pulmonary edema is being treated with IV Dobutamine. What is the primary goal of administering this medication?

A. To reduce preload
B. To improve oxygenation
C. To enhance cardiac output
D. To dilate the airways

A

C. To enhance cardiac output

Rationale: Dobutamine is a positive inotropic agent used to enhance cardiac output by increasing the contractility of the heart in patients with pulmonary edema and heart failure.

329
Q

A nurse is educating a patient about the risk factors for pulmonary edema. Which of the following conditions should the nurse emphasize as a major cause of this condition?

A. Right-sided heart failure
B. Chronic obstructive pulmonary disease (COPD)
C. Left-sided heart failure
D. Pneumonia

A

C. Left-sided heart failure

Rationale: Left-sided heart failure is the most common cause of pulmonary edema, as it leads to fluid accumulation in the lungs due to inadequate pumping of the left ventricle.

330
Q

A patient with pulmonary edema has been prescribed non-invasive ventilation (BiPAP). What is the purpose of this intervention?

A. To provide continuous positive pressure during exhalation
B. To prevent aspiration of fluid into the lungs
C. To reduce fluid retention in the body
D. To improve the patient’s ability to sleep

A

A. To provide continuous positive pressure during exhalation

Rationale: BiPAP provides positive pressure during exhalation, which helps to improve oxygenation and ventilation by preventing the collapse of the alveoli and improving gas exchange in patients with pulmonary edema.

331
Q

A nurse is caring for a patient with pulmonary edema and is monitoring urinary output. Why is this an important parameter to assess?

A. To monitor for signs of dehydration
B. To assess for complications related to mechanical ventilation
C. To track the progression of heart failure
D. To evaluate kidney function related to diuretic therapy

A

D. To evaluate kidney function related to diuretic therapy

Rationale: Urinary output is monitored to assess the effectiveness of diuretic therapy, which helps remove excess fluid from the body in patients with pulmonary edema.

332
Q

A patient with pulmonary edema has been receiving furosemide (a diuretic). The nurse notes that the patient’s serum potassium level is 3.2 mEq/L. What action should the nurse take?

A. Administer potassium supplements as ordered
B. Withhold the diuretic and notify the healthcare provider
C. Continue monitoring the potassium level, as it is within normal limits
D. Administer a potassium-sparing diuretic instead of furosemide

A

A. Administer potassium supplements as ordered

Rationale: A potassium level of 3.2 mEq/L is below the normal range, indicating hypokalemia. Potassium supplements are necessary to prevent complications associated with low potassium levels, especially after diuretic therapy.

333
Q

A patient is admitted with pulmonary edema secondary to left-sided heart failure. Which of the following nursing interventions is a priority in managing this patient?

A. Administer a sedative to reduce anxiety
B. Position the patient in a high Fowler’s position
C. Restrict fluid intake to less than 1 liter per day
D. Encourage deep breathing and coughing exercises

A

B. Position the patient in a high Fowler’s position

Rationale: Positioning the patient in high Fowler’s position improves lung expansion, reduces venous return to the heart, and eases breathing in patients with pulmonary edema

334
Q

A patient develops pulmonary edema after an allergic reaction. Which of the following mechanisms is most likely responsible for the pulmonary edema in this patient?

A. Increased capillary permeability due to histamine release
B. Increased hydrostatic pressure from the heart’s inability to pump
C. Decreased oxygenation in the blood due to airway obstruction
D. Decreased lymphatic drainage from the lungs

A

A. Increased capillary permeability due to histamine release

Rationale: Anaphylactic reactions release histamines and other mediators that increase the permeability of blood vessels, allowing fluid to leak into the lungs and causing pulmonary edema.

335
Q

A patient with pulmonary edema after a near-drowning incident is receiving treatment. Which of the following factors most likely caused the pulmonary edema in this patient?

A. Increased hydrostatic pressure from right-sided heart failure

B. Hypoxemia leading to constriction of the pulmonary vasculature

C. Fluid overload due to intravenous rehydration therapy

D. Aspiration of water leading to increased lung permeability

A

D. Aspiration of water leading to increased lung permeability

Rationale: Near-drowning incidents can cause aspiration of water into the lungs, which leads to increased capillary permeability, allowing fluid to leak into the alveoli and cause pulmonary edema.

336
Q

A nurse is educating a patient about potential causes of pulmonary edema. Which of the following conditions should the nurse emphasize as a common cause due to altered capillary permeability?

A. Pneumonia
B. Liver cirrhosis
C. Left-sided heart failure
D. Chronic kidney disease

A

A. Pneumonia

Rationale: Pneumonia is a common cause of pulmonary edema due to increased capillary permeability resulting from inflammation in the lungs. This leads to fluid leakage into the alveoli, causing pulmonary edema.

337
Q

Which assessment finding requires immediate intervention in a client with pulmonary edema?

a. Oxygen saturation of 92%
b. Respiratory rate of 28 breaths/min
c. Use of accessory muscles to breathe
d. Bilateral 2+ pitting edema in the lower extremities

A

c. Use of accessory muscles to breathe

Rationale: Use of accessory muscles indicates significant respiratory distress and impaired oxygenation, requiring immediate intervention.

338
Q

What diagnostic study would confirm pulmonary edema in a client with worsening dyspnea?

a. Chest X-ray
b. Arterial blood gas analysis
c. Pulmonary function test
d. Echocardiogram

A

a. Chest X-ray

Rationale: A chest X-ray reveals fluid accumulation in the lungs, characteristic of pulmonary edema, confirming the diagnosis.

339
Q

The nurse is caring for a client with acute pulmonary edema. Which medication is most important to administer first?

a. Morphine sulfate
b. Nitroglycerin IV
c. Furosemide IV
d. Albuterol nebulizer

A

c. Furosemide IV

Rationale: Furosemide rapidly reduces fluid overload by promoting diuresis, addressing the primary issue of pulmonary edema.

340
Q

Which client is at the highest risk for developing pulmonary edema?

a. A client with chronic kidney disease and fluid retention
b. A client with mild hypertension on diuretics
c. A client with a history of asthma and recent steroid use
d. A client with hypovolemia after surgery

A

a. A client with chronic kidney disease and fluid retention

Rationale: Fluid retention increases the risk of pulmonary edema due to volume overload and increased hydrostatic pressure in the pulmonary vasculature.

341
Q

What is the primary pathophysiology of mitral stenosis?

a. Narrowing of the mitral valve orifice, impeding blood flow from the left atrium to the left ventricle

b. Regurgitation of blood from the left ventricle to the left atrium during systole

c. Thickening of the aortic valve, restricting blood flow to the systemic circulation

d. Dilation of the left ventricle causing backward blood flow into the left atrium

A

a. Narrowing of the mitral valve orifice, impeding blood flow from the left atrium to the left ventricle

Rationale: Mitral stenosis is characterized by the narrowing of the mitral valve, reducing blood flow from the left atrium to the left ventricle and leading to increased atrial pressure.

342
Q

A client with suspected mitral stenosis undergoes diagnostic testing. What is the gold standard test to confirm valvular heart disease?

a. Chest X-ray
b. Electrocardiogram (ECG)
c. Transesophageal echocardiography (TEE)
d. Cardiac catheterization

A

c. Transesophageal echocardiography (TEE)

Rationale: TEE provides detailed visualization of the mitral valve, allowing for accurate assessment of the severity and extent of stenosis.

343
Q

What clinical finding is most commonly associated with mitral stenosis?

a. Systolic murmur at the left sternal border
b. Diastolic murmur at the apex with an opening snap
c. Continuous murmur heard at the base of the heart
d. Holosystolic murmur radiating to the axilla

A

b. Diastolic murmur at the apex with an opening snap

Rationale: Mitral stenosis is characterized by a low-pitched diastolic murmur best heard at the apex, often accompanied by an opening snap due to stiffened valve leaflets.

344
Q

A client with mitral stenosis reports worsening dyspnea and fatigue. What is the most likely underlying cause of these symptoms?

a. Left ventricular hypertrophy
b. Pulmonary congestion from elevated left atrial pressure
c. Coronary artery disease
d. Systemic hypertension

A

b. Pulmonary congestion from elevated left atrial pressure

Rationale: In mitral stenosis, blood flow obstruction increases left atrial pressure, leading to pulmonary venous congestion and symptoms like dyspnea and fatigue.

345
Q

The nurse is educating a client about mitral stenosis and its diagnostic process. Which statement by the client indicates the need for further teaching?

a. “A transesophageal echocardiogram gives detailed images of my heart valves.”
b. “I may need a chest X-ray to look for an enlarged heart.”
c. “A cardiac catheterization is the best way to diagnose mitral stenosis.”
d. “The echocardiogram will help measure the severity of my valve disease.”

A

c. “A cardiac catheterization is the best way to diagnose mitral stenosis.”

Rationale: While cardiac catheterization can assess pressures and gradients, the gold standard for diagnosing mitral stenosis is echocardiography, specifically TEE.

346
Q

Which of the following best describes a pleural effusion?

A. A disease of the pleural membrane
B. An abnormal collection of fluid in the pleural space
C. A condition caused by decreased pulmonary capillary pressure
D. A disease primarily affecting the lymphatic system

A

B. An abnormal collection of fluid in the pleural space

Rationale: A pleural effusion is not a disease but a sign of another condition, characterized by the abnormal accumulation of fluid in the pleural space.

347
Q

A nurse is caring for a patient with a pleural effusion. Which factor is most likely to cause the fluid accumulation in the pleural space?

A. Decreased pulmonary capillary pressure
B. Increased oncotic pressure
C. Decreased capillary membrane permeability
D. Obstruction of lymphatic flow

A

D. Obstruction of lymphatic flow

Rationale: Fluid accumulation in the pleural space can occur due to obstruction of lymphatic flow, which impairs the drainage of fluid from the pleural space.

348
Q

A pleural effusion occurs when there is an imbalance in which of the following pressures?

A. Hydrostatic pressure and interstitial pressure
B. Oncotic pressure and pulmonary capillary pressure
C. Hydrostatic pressure, oncotic pressure, and capillary membrane permeability
D. Pulmonary capillary pressure and lymphatic flow

A

C. Hydrostatic pressure, oncotic pressure, and capillary membrane permeability

Rationale: The balance between hydrostatic pressure, oncotic pressure, and capillary membrane permeability governs fluid movement in and out of the pleural space. An imbalance leads to fluid accumulation.

349
Q

A nurse is educating a patient about pleural effusion. The nurse should explain that pleural effusion is often a sign of:

A. A primary lung disease
B. An underlying condition affecting fluid balance
C. A bacterial infection of the lungs
D. A problem with airway obstruction

A

B. An underlying condition affecting fluid balance

Rationale: Pleural effusion is not a primary lung disease but a sign of an underlying condition, often one that disrupts fluid balance in the pleural space.

350
Q

A nurse is caring for a patient with a transudative pleural effusion. Which of the following characteristics is most likely to be seen in the fluid?

A. High protein content
B. Cell-rich fluid
C. Clear, pale yellow fluid
D. Purulent fluid

A

C. Clear, pale yellow fluid

Rationale: A transudative pleural effusion typically consists of protein-poor, cell-poor fluid, which is usually clear and pale yellow.

351
Q

Which of the following conditions is most commonly associated with the development of a transudative pleural effusion?

A. Pneumonia
B. Lung cancer
C. Tuberculosis
D. Heart failure

A

D. Heart failure

Rationale: Transudative pleural effusions often occur in non-inflammatory conditions, such as heart failure, where there is increased hydrostatic pressure that promotes fluid accumulation.

352
Q

A patient has a transudative pleural effusion caused by hypoalbuminemia. Which condition is most likely to be the underlying cause of the effusion?

A. Chronic liver disease
B. Pneumonia
C. Lung abscess
D. Malignant tumor

A

A. Chronic liver disease

Rationale: Hypoalbuminemia, which causes decreased oncotic pressure, is commonly associated with conditions like chronic liver disease or renal disease, leading to transudative pleural effusion.

353
Q

Which of the following is characteristic of an exudative pleural effusion?

A. Protein-poor fluid
B. Clear, pale yellow fluid
C. Rich in protein
D. Associated with heart failure

A

C. Rich in protein

Rationale: Exudative pleural effusions are characterized by fluid that is rich in protein and typically occurs due to an inflammatory response, often caused by infections or cancer.

354
Q

Which of the following conditions is a common cause of empyema?

A. Tuberculosis
B. Heart failure
C. Pneumonia
D. Chronic liver disease

A

C. Pneumonia

Rationale: Empyema, a collection of purulent fluid in the pleural space, is commonly caused by infections such as pneumonia, tuberculosis, lung abscesses, or infected chest wounds.

355
Q

A nurse is educating a patient with a pleural effusion about the difference between transudative and exudative types. Which statement should the nurse include in the teaching?

A. “Transudative effusions are typically associated with infections, while exudative effusions occur due to conditions like heart failure.”

B. “Exudative effusions have high protein content, while transudative effusions have low protein content.”

C. “Transudative effusions occur due to inflammation, while exudative effusions are caused by a reduction in hydrostatic pressure.”

D. “Exudative effusions are generally clear and pale yellow, while transudative effusions are purulent.”

A

B. “Exudative effusions have high protein content, while transudative effusions have low protein content.”

356
Q

Which clinical manifestation is most commonly associated with a pleural effusion?

a. Bilateral wheezing
b. Decreased breath sounds on the affected side
c. Stridor during inspiration
d. Hyperresonance to percussion over the affected area

A

b. Decreased breath sounds on the affected side

Rationale: Pleural effusion reduces lung expansion, leading to decreased or absent breath sounds over the affected area.

357
Q

A nurse is assessing a client with a suspected pleural effusion. Which finding is most likely on physical examination?

a. Tracheal deviation toward the affected side
b. Increased tactile fremitus over the affected area
c. High-pitched crackles on the affected side
d. Dullness to percussion over the lower lobes

A

d. Dullness to percussion over the lower lobes

Rationale: Pleural effusion causes fluid accumulation, leading to dullness on percussion over the area of fluid collection.

358
Q

A client with a large pleural effusion reports shortness of breath. What is the primary cause of this symptom?

a. Collapse of alveoli in the affected lung
b. Bronchospasm and airway narrowing
c. Decreased oxygen-carrying capacity of the blood
d. Reduced chest wall compliance due to pleuritic pain

A

a. Collapse of alveoli in the affected lung

Rationale: Pleural effusion compresses the lung, reducing alveolar expansion and leading to dyspnea.

359
Q

Which clinical symptom might suggest that a pleural effusion is progressing and requires immediate intervention?

a. Dry, nonproductive cough
b. Low-grade fever and chills
c. Gradual increase in dyspnea and fatigue
d. Sudden onset of severe chest pain and cyanosis

A

d. Sudden onset of severe chest pain and cyanosis

Rationale: Severe chest pain and cyanosis may indicate tension pneumothorax or other complications of pleural effusion, requiring immediate evaluation.

360
Q

During assessment, the nurse notes asymmetrical chest expansion in a client with pleural effusion. What is the best explanation for this finding?

a. Air trapping in the affected lung
b. Reduced movement of the affected lung due to fluid accumulation
c. Bronchial obstruction on the affected side
d. Overcompensation by the unaffected lung

A

b. Reduced movement of the affected lung due to fluid accumulation

Rationale: Fluid in the pleural space restricts lung expansion on the affected side, resulting in asymmetrical chest movement.

NUR251 - Medical Surgical III (6 decks)

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