Unit 6 Flashcards
1
Q
Chapter 25- patho
nurse is teaching a client the correct technique for taking an arterial pulse. The nurse explains that the pulsations are:
A. Turbulence of the blood flow
B. Korotkoff sounds
C. Blood flow in the veins
D. Pressure pulses
A
D. Pressure points
2
Q
Considering how hydrostatic forces affect the capillaries, which of the following would increase capillary hydrostatic pressure most?
Increase in venous pressure
Decrease in arterial pressure
Decrease in gravity when standing
Increase in small-artery pressure
A
A. Increase in venous
3
Q
Which of the following is true regarding pulmonary circulation?
A. It consists of the left side of the heart, the aorta, and its branches.
B. The system functions with an increased arterial pressure to circulate through the distal parts of the body.
C. It is the larger of the two circulatory systems.
D. It is a low-pressure system that allows for improved gas exchange.
A
D. It is a low pressure system
4
Q
nurse is caring for a client with right heart failure caused by pulmonary hypertension. Which hemodynamic parameter is most appropriate for the nurse to monitor?
A. Systemic vascular resistance (SVR)
B. Central venous pressure (CVP)
C. Blood pressure
D. Pulmonary arterial pressure (PAP)
A
D. Pulmonary arterial pressure
5
Q
client has had an acute myocardial infarction (MI). The brother of the client has a history of angina. The client asks how he will know if his brother’s pain is angina or if the brother is actually having an MI. Which statement is correct?
A. Chest pain with angina only occurs at rest; MI pain occurs during a stressful time.
B. Pain is more severe and lasts longer with angina than with an MI.
C. Rest and intake of nitroglycerin relieve chest pain with angina; they do not relieve chest pain with an MI.
D. Chest pain with angina only occurs during the day; Ml pain is more likely at night.
A
C. Nitro
6
Q
Which factor represents the amount of blood that the heart must pump with each beat and is determined by the stretch of the cardiac muscle fibers and the actions of the heart prior to cardiac contraction?
A. Preload
B. Cardiac contractility
C, heart rate
D, after load
A
A. Preload
7
Q
The nurse is caring for a client with severe aortic stenosis. What affect to cardiac afterload will the nurse note?
• Less pressure recorded on the cardiac output due to poor leaflet contactivity
• Pulse rate will decrease due to less blood being ejected from the heart
• Greatly elevated systolic pressure when measured with hemodynamic setting
• Blood pressure will be below normal due to the narrowing of the valve outlet
A
C. Greatly elevated systolic pressure
8
Q
Which related circulatory complication can result from surgical treatment for metastatic breast cancer?
• Hypotension upon standing
• Tachycardia when at rest
• Lymphedema in the affected arm
Irregular heart rate
A
C. Lymphedema in the affected arm
9
Q
Which neurotransmitter is associated with the parasympathetic nervous system?
• Acetylcholine
• Norepinephrine
• Epinephrine
Dopamine
A
A. Acetylcholine
10
Q
When a client experiences the Cushing reflex, what occurs with the body?
• An increase in arterial pressure to levels above the intracranial pressure -
• The toes fan outward in response to stimulation being applied to the bottom of the foot.
• The pupils contract in response to light exposure.
• The systemic blood pressure decreases to restore equal amounts of oxygen throughout the body.
A
A. And increase in arterial pressure
11
Q
While intubated for surgery, a client has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?
• Decreased heart rate as a result of parasympathetic innervation of the heart
Decreased vascular perfusion due to parasympathetic stimulation
• Decreased heart rate as a result of impaires acetyicholine reuptake
Decreased heart rate, contractility, and afterload
A
A. Decreased heart rate as a result of parasympathetic innervation of the heart
12
Q
Select the correct sequence of blood return to the heart.
A. Capillaries, venules, veins, left atrium
B. Capillaries, arterioles, veins, left atrium
C. Capillaries, venules, veins, right atrium
D. Capillaries, arterioles, arteries, right atrium
A
C. Capillaries, venues, veins, RA
13
Q
The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent?
• Repolarization of the ventricles
Depolarization of the ventricular conduction system
Repolarization of the atrium
Depolarization of the sinoatrial node
A
A. Repolorization of the ventricles
14
Q
Which statements are true regarding the capillary system? Select all that apply.
A. Flow into the system is controlled by colloidal osmotic pressure.
B. Normal function requires that all fluid that leaves the capillary beds be reabsorbed.
C. Flow out of the system is controlled by hydrostatic pressure.
D. Fluid leaves the capillary beds via lymphatic channels.
E. Albumin plays a significant role in maintaining the function of this system.
A
ACE
15
Q
Which client is most likely to be experiencing vasodilation?
A. A 32-year-old man who takes a selective serotonin reuptake inhibitor for treatment of depression
B. A 51-year-old man with a history of hypertension who is taking a medication that blocks the effect of the renin-angiotensin-aldosterone system
C. A 30-year-old woman who takes antihistamines to treat her seasonal allergies
D. A 9-year-old boy who has been given an injection of epinephrine to preclude an anaphylactic reaction to a bee sting
A
B. Angiotensin is a potent vasoconstrictor, and medications that block this induce vasodilation. Epinephrine is also a vasoconstrictor. Histamine is a medications are likely to induce vasoconstriction. Serotonin is a vasoconstrictor, so medications that block its reuptake and increase free levels : vasoconstriction.
16
Q
Which of the following blood flow patterns reduces friction, allowing the blood layers to slide smoothly over one another?
A. Axially
B. Turbulent
C. Laminar
D. Crosswise
A
C. Laminar
17
Q
A nurse is reviewing an echocardiogram for a client with a congenital defect in the papillary muscles of the heart. Based on this result, which assessment should the nurse complete?
A. Palpate the pericardium for a heave or thrill.
B. Monitor the blood pressure.
C. Auscultate for an extra heart sound due to incomplete semilunar valve closure.
D. Auscultate for a murmur caused by the backward expulsion of blood through the atrioventricular valves.
A
D. When closed, the AV valves prevent backflow of blood from the ventricles to the atria during systole. The AV valves are supported by the papillary muscles, which project from the wall of the ventricles. Contraction of the papillary muscles at the onset of systole ensures closure by producing tension on the leaflets of the AV valves before the full force of ventricular contraction pushes against them.
18
Q
Which blood vessels function without 3 muscle layers
A. Capillaries
B, arteries
C. Arterioles
D, veins
A
A. Capillary
19
Q
Which organ has larger capillary pores to allow the exchange of gases, nutrients, and/or waste products?
A. Kidney
B. Brain
C. Blood brain barrier
D. Liver
A
D. Liver
20
Q
A client’s echocardiogram identified a narrowed valve that has resulted in a decreased blood flow between the left atria and left ventricle. The nurse would interpret this as the:
A. Tricuspid valve
B. Aortic valve
C, bicuspid valve
D, pulmonic valve
A
C. Bicuspid valve
21
Q
Chapter 26
A client has been diagnosed with deep vein thrombosis (DVT). The nurse is planning care and recognizes that the client is most at risk for:
A. Pulmonary embolism
B. Arterial insufficiency
C, polyarteritus
D. Vasculitis
A
A. Pulmonary embolism
22
Q
The nurse is discussing risk factors for hypertension with a client. Which factors are nonmodifiable risk factors for development of hypertension? Select all that apply.
A. Obesity
B. Advanced age
C, ethnicity
D. Low dietary potassium
E, excess salt consumption
A
BC
23
Q
A client presents to the emergency department reporting bilateral cyanosis and pallor of the fingers after being out in the cold weather for 5 minutes. The toes are of normal color.
What is a potential diagnosis for this client?
A. Raynaud disease
B. DVT
C. Frostbite r/t hypothermia
D. Atherosclerotic occlusive disease
A
A. Raynauds
24
Q
Which individual is at greatest risk for developing a venous thrombosis resulting from venous stasis?
A. Client in the terminal stage of cancer
B. Pregnant woman
C. Client on bed rest
D. Dehydrated client
A
C. Client on bed rest
25
The health care provider is teaching a client about modifiable risk factors for atherosclerosis. The most appropriate information to provide would be:
A. HTN
B. Family history of heart disease
C. Being male
D, 55 years of age
A. Hypertension
26
When will the nurse plan to assess a client's blood pressure to confirm the possible diagnosis of orthostatic hypotension?
• Within a half-hour after the heaviest meal of the day
In the morning before arising from bed
In the evening just before sleep
• Midmorning right after taking a short walk
B. In the morning h before arisi g from bed, then stand and do it again
27
The health care provider is reviewing the results of a client's magnetic resonance imaging (MRI). The results indicate a small spherical dilation at the circle of Willis. The provider would interpret this as:
A. Saccular aneurysm
B. Suitor aneurysm
C. Berry aneurysm
D. Dissecting aneurysm
C. Berry aneurysm. (Fusiform one a gradual progressive dilation of vessel)
28
Which are the primary treatment options for a client with DVt
Sitting
Elastic support
Elevation of the legs with flexion at the knees
Application of heat
Bed rest
Elastic support, application of heat and bed rest
Rationale:
The objectives of treatment of venous thrombosis are to prevent the formation of additional thrombi, prevent extension and embolization of existing thrombi, and minimize venous valve damage. A 15- to 20-degree elevation of the legs prevents stasis. It is important that the entire lower extremity or extremities be carefully extended to avoid acute flexion of the knee or hip. Heat often is applied to the leg to relieve venospasm and to aid in the resolution of the inflammatory process. Bed rest usually is maintained until local tenderness and swelling have subsided. Gradual ambulation with elastic support is then permitted. Standing and sitting increase venous pressure and are to be avoided. Elastic support is needed for 3 to 6 months to permit recanalization and collateralization and to prevent venous insufficiency.
29
A client is diagnosed with orthostatic hypotension. The nurse knows that which drugs can predispose the client to orthostasis? Select all that apply.
A. Bronchodilators
B, diuretics
C. Anti hypertensive
D, antibiotics
E. Psychotropic
BC and E
30
A teenager is diagnosed with hypertension. The nurse knows that risk factors for hypertension in children and adolescents include which of these? Select all that apply.
A. Obesity
B. High salt
C. Female
D. Poor performance in school
E. Inactive lifestyle
AB E
31
An older adult client is prescribed a vasodilator for hypertension. Which adverse effect is of greatest concern for an older adult taking this class of drug?
A. Hypotension
B. Dry mouth
C. Constipation
D, restlessness
A. Hypotension
32
Which of the following are characteristic signs of acute arterial embolism?
•Paralysis, warmth, and paranoia
Pallor, pulselessness, and pain
Pain, increased blood pressure, and warmth
Purpura, muscle weakness, and shortness of breath
B. Pallor, pulselessness and pain
The presentation of acute arterial embolism is often described as that of the seven Ps: pistol shot (acute onset), pallor, polar (cold), pulselessness, pain, paresthesia, and paralysis.
33
The physician's order states, "Calculate the pulse pressure of the client's B/P." The blood pressure reading is as follows: systolic pressure of 146 mm Hg and a diastolic pressure of 82 mm Hg. The pulse pressure would be:
A. 228
B. 64
C. 41
D. 73
B. 64 (difference between systolic and diastolic)
34
A 65-year-old male client is diagnosed with systolic hypertension. The nurse educates the client about how the aging process and development of stiff, large arteries can result in which physiologic occurence? Select all that apply.
Unstable blood pressure
Increased diastolic pressure
Widened pulse pressure
Decreased diastolic pressure
Increased systolic pressure
CDE Rationale:
The stiffening of the large arteries results in increased systolic pressure. Diastolic pressure may decrease or remain unchanged. The pulse pressure widens as systolic pressure rises. Stiffening of the arteries does not produce unstable blood pressure
35
The nurse knows that the main objective of the management of hypertension is to achieve a sustainable level of blood pressure below:
100/60
140/90
100/90
140/60
140/90
36
Which client is at greatest risk for orthostatic hypotension?
• A 66-year-old postoperative client on bed rest
• A 42-year-old male client with history of pulmonary embolism
•A 20-year-old pregnant client at 36 weeks' gestation
•A 70-year-old female client who has taken the same antihypertensive medication for 10 years
A. Bed rest
37
The nurse is developing a plan of care for a postsurgical client. A major goal is to prevent the formation of prevent deep vein thrombosis (DVT). The most important int for the nurse to implement would be:
A. Ice to dvt hourly
B. Bed rest
C. Apply sequential pneumatic compression to lower extremities
D. Massage legs to maintain blood flow
C. Sequential pressure
38
The nurse is providing education to a client diagnosed with varicose veins. The nurse determines that teaching has been effective when the client states that which activity is most likely the cause of the varicosities?
A. Rapid wt loss
B. Weak bone structure
C. Prolonged sitting
D. Heavy lifting
D. Heavy lifting
39
A pregnant female client is at risk for the development of preeclampsia-eclampsia. Select the most important data to assess.
• Blood pressure 90/60 and proteinuria in the second trimester
• Blood pressure 140/90 and glucose in the urine during the 36th week of pregnancy
•Blood pressure 160/100 mm Hg and proteinuria during the 30th week of pregnancy
• Blood pressure 130/88 and hyperglycemia occurring during the 22nd week of pregnancy
BP 160/100
Rationale:
Preeclampsia eclampsia is defined as an elevation in blood pressure (systolic >140 mm Hg or diastolic >90 mm Hg) and proteinuria (300 or greater in 24 hours) developing
after 20 weeks of gestation.
40
A client has been diagnosed with a dissecting aortic aneurysm. It is most important for the nurse to assess the client for:
Late hypertensive crisis
Chest pain radiating to the right arm
Tearing or ripping-type pain in the chest or back
Tonic-clonic seizures
Tearing or ripping
Rationale:
A major symptom of a dissecting aneurysm is the abrupt presence of excruciating pain, described as tearing or ripping. Pain associated with dissection of the ascending aorta frequently is located in the anterior chest, and pain associated with dissection of the descending aorta often is located in the back. In the early stages, blood pressure typically is moderately or markedly elevated.
41
Chapter 27
The diagnosis is hypovolemic shock. The nurse knows that causes of hypovolemic shock include which of the following? Select all that apply.
A. Excessive vasoconstriction
B. 15% blood volume loss
C. MI
D, severe dehydration
E. Severe burns
BDE
42
The nurse has just completed teaching a client about acyanotic congenital heart disease. The nurse determines that teaching was effective when the client states the blood is shunted to which part of the body?
• Left lung to the right lung
•Right side of the heart to the left side of the heart
• Right lung to the left lung
• Left side of the heart to the right side of the heart
D. Left to right
Rationale:Defects that result in a left-to-right shunt are categorized as acyanotic disorders since they do not compromise oxygenation of blood in the pulmonary circul
43
The nurse is caring for a client with chronic heart failure. Which drug category may be pescribed for acute heart failure to improve heart performance by decreasing preload?
A. Beta-adrenergic receptor blocking agents like atenolol
B. Cardiac glycosides like digitalis
C. Vasodilator drugs like nitroprusside
D. ACE inhibitors like captopril
C. Vasodilators
44
The nurse is preparing to auscultate for a mitral valve stenosis murmur. Where is the best location to place the stethoscope?
A. At the carotid arteries
B. Over the aorta
C. At the apex of the heart
D. Over the sternum
C. At the apex of the heart
45
The nurse is developing a plan of care for a client diagnosed with stable angina. Select the most important goal for this client.
A. Ensuring adequate oxygenation with continuous oxygen administration
B. Assisting the client to return to previous lifestyle
C. Preventing clotting disorders
D. Myocardial infarction prevention
D. Prevevting MI
46
A preventive measure to decrease the risk of developing rheumatic heart disease includes:
• prompt diagnosis of streptococcal infections with a throat culture. scheduling regular hearing examinations.
• yearly electrocardiography after the age of 50.
• blood specimen assessed for rheumatoid factor.
A. Throat culture
47
Which serum biomarker is highly specific for myocardial tissue?
C-reactive protein
Creatine kinase
Troponin
White blood cells
Troponin
48
What is the most common identifiable cause of secondary cardiomyopathy?
Heart transplant
Alcohol abuse
Genetic abnormalities
Heart failure
Alcohol abuse
49
Exudate in the pericardial cavity is a characteristic of which cardiac condition?
Acute pericarditis
Pericardial effusion
Constrictive pericarditis
Cardiac tamponade
Pericardial effusion
50
The nurse is monitoring hourly urine output of a client diagnosed with hypovolemic shock. The nurse is most concerned if the client's output is:
60ml
40
20
80
20ml/hour
51
A 75-year-old client is being evaluated for heart failure. Which questions will the nurse ask to confirm common signs and symptoms observed in older adults experiencing heart failure? Select all that apply.
• "Are you eating more than usual?"
Do you have swelling in your ankles?"
"Are you feeling depressed?"
Do you get up often during the night to urinate?"
"Do you easily get tired?"
BCDE
52
<众
A 62-year-old female client presents to the emergency department and is diagnosed with acute heart failure syndrome. Which assessment finding would the nurse expect?
A. Slowed breathing and dehydration.
B. Increased urination and dry skin.
C. Productive cough with frothy sputum.
D. Shortness of breath and bradycardia.
C. Productive cough
Rationale:
The signs and symptoms of acute heart failure syndromes include shortness of breath and other respiratory manifestations (i.e., exertional dyspnea, orthopnea), fatigue and limited exercise tolerance, fluid retention and edema, cachexia and malnutrition, and cyanosis. Acute pulmonary edema is the most dramatic symptom of AHFS. The client would have an increased heart rate as a result of the exertional process.
53
When an acute event occurs and the circulatory system can no longer provide the body with adequate perfusion of its tissues and organs, cellular hypoxia occurs and the body goes into shock. What are the causes of shock in the human body? Select all that apply.
■ Hypervolemia
• Maldistribution of blood flow
Excessive vasoconstriction
Hypovolemia
Obstruction of blood flow
B. Maldistribution of blood flow,
D. Hypovolemia
E. Obstruction of blood flow
54
In distributive shock, there are abnormalities in vascular resistance. Which type of shock display the same pattern?
• Neurogenic
Septic
_ Hypovolemic
_ Anaphylactic
Cardiogenic
Neurogenic, septic and anaphylactic
Rationale:
In distributive shock, the capacity of the vascular compartment is greatly enlarged so that a normal blood volume becomes insufficient. In neurogenic shock, loss of sympathetic (adrenergic) control of blood vessels is lost and extreme vasodilation occurs. In anaphylactic shock, a severe allergic reaction, massive release of histamine induces extreme vasodilation. In septic shock, a response to severe infection, there is vascular dilation. Cardiogenic shock is a loss of ventricular contractility. Hypovolemic shock is a loss of blood volume.
55
A client with a known history of intravenous drug abuse has been diagnosed with infective endocarditis. Select the most likely cause of infection.
A. Actinobacillus actinomycetemcomitans
B. Staphylococcus aureus
C. Kingella kingae
D. Eikenellla corrodens
B. Staph
56
A client has developed constrictive pericarditis and myocardial hypertrophy. Select the most likely cause.
A. Backward failure
B. Diastolic dysfunction
C. Systolic dysfunction
D. Frontward failure
B. Diastolic dysfunction Rationale:
The conditions that cause diastolic dysfunction are those that impede expansion of the ventricles (i.e., pericarditis), those that increase ventricular wall thickness and reduce chamber size (i.e., myocardial hypertrophy), and those that delay diastolic relaxation (i.e., aging).
57
A child is suspected to have heart failure. The nurse knows that which statements regarding heart failure in children are most accurate? Select all that apply.
• Physical activity must be discouraged.
Inotropic agents such as digoxin may be used in children.
The etiology of heart failure is similar in children and adults.
Symptoms include tachypnea and tachycardia.
Congenital defects are a risk factor.
BDE
Rationale:
The etiology of heart failure in children is different from that in older adults. Causes in children include congenital abnormalities and genetic cardiomopathy. Signs and symptoms include fatigue, effort intolerance, cough, anorexia, abdominal pain, and impaired growth, as well as tachypnea and tachycardia. Surgery can correct some underlying defects.
Drugs such as digoxin and diuretics are used when medical management is required. Clients should be as active as their cardiac function supports.
58
The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be:
A. placing a stent for fluid drainage from the heart.
B. eliminating CHF through curing the disease.
C. maintaining higher oxygen levels to decrease the work of breathing.
D. improving quality of life by relieving symptoms.
D. Improving quality
59
What is the most important factor in myocardial oxygen demand?
A. Hyperthermia
B. Degree of anxiety
C. Respiratory rate
D, heart rate
Heart rate - because as heart rate decreases, myocardial oxygen demands increase
60
A client with a history of acute coronary syndrome asks why she needs to take aspirin 81 mg every day. The most appropriate response by the nurse would be:
"Aspirin will prevent a heart attack."
"Aspirin will help prevent blood clotting."
"It will give you a steady relief of your chest pain."
"Aspirin prevents blood clotting by halting platelet production."
Will prevent blood clotting
61
Chapter 28
Which of the following is called the pacemaker of the heart?
Bundle of His
Purkinje fibers
Arterioventricular (AV) node
Sinoatrial (SA) node
SA node
62
The nurse is assessing a client said to be in sinus rhythm. What do you expect to find when looking at the ECG?
A. Irregular rhythm
B, Constant R to R intervals
C. A "P" before every QRS wave
D. A rate between 60 and 100 beats per minute
E. Absence of T waves.
BCD
63
A client has been diagnosed with runs of intermittent ventricular tachycardia where the client loses consciousness and needs to be stimulated to recovery. Knowing this history, the nurse will educate the client about which treatment intervention/procedure that will depolarize the heart to allow the sinoatrial node to regain control of the heart?
Education involving automatic implantable cardioverter-defibrillators implantation
The benefits of ablation therapy bi-monthly
Immediate pacemaker implantation
The benefits of antiarrhythmic drugstand possible side effects
A. Education about automatic implantable cardio better defibrillators implantation
64
Which dyshythmia is considered to be the most fatal and requires immediate treatment?
Premature atrial contractions
Ventricular fibrillation
Premature ventricular contractions
Atrial flutter
B. VF
65
A client experiencing a sinus arrest would demonstrate which symptom or finding?
Prolonged periods of asystole demonstrated on an electrocardiogram
Spontaneous persistent sinus bradycardia
Heart rate of greater than 100 beats/min
P-wave that occurs more frequently than expecte
A. Prolonged periods of asystole on an ECg
66
A client admitted to the emergency department is experiencing sinus tachycardia. What can cause this dyshythmia that the nurse should monitor for? Select all that apply.
A. Blood loss
B. Hyperthyroidism
C. Fever
D. Pain
E. Insomnia
ABCD
(Not insomnia)
67
In which atrioventricular (AV) conduction disorder does the link between the atria and ventricles get lost, resulting in atrial and ventricular depolarization being controlled by separate pacemakers?
First-degree AV block
Premature ventricular contractions
Third-degree AV block
Second-degree AV block
Third degree block
Rationale:
The occurrences described explains third-degree block. In first-degree block the AV conduction is delayed, but all impulses do get conducted. With second-degree block some impulses may get through while others do not. Premature ventricular contractions results in the ventricles contracting early.
68
A client presents with sinus bradycardia. What is the nurse's best action?
Increase the client's monitoring
Assess the client's cardiac output
Assess the client's history
Admit the client to the intensive care unit
Clients history
Rationale:
The nurse needs to assess the client's history before determining if action is necessary. Sinus bradycardia is most often benign unless it is associated with a myocardial infarction, post-resuscitation, or associated with hemodynamic decompensation. It is normal in an athlete, or someone who is well conditioned. After assessing the client's history, the nurse can determine if other action is necessary.
69
Which of the following occurs during repolarization?
Positively charged Na+ moves outward across the cell membrane
Positively charged K+ moves outward across the cell membrane
Positively charged K+ moves into the cell membrane
Positively charged Na+ moves into the cell membrane
B. Positive K moves outward
70
The purpose of a cardioversion device is the treatment of which cardiac disorder?
Atrial fibrillation
Symptomatic bradycardia
Ventricular fibrillation
Sinus tachycardia
Atrial fibrillation
71
Which statement describes the greatest diagnostic limitation of an electrocardiogram (ECG)?
It is an expensive diagnostic tool.
It is an invasive procedure.
It documents only current cardiac function.
It can interfere with the heart's conduction system.
Only current cardiac function
72
Paroxysmal supraventricular tachycardia arises from which form of reentry?
Arterioventricular (AV) nodal
True
Bundle of His nodal
Orthodromic
A. Arterioventricular nodal
73
Which degree of heart block results in decreased cardiac output and fainting?
First-degree
Second-degree Type II
• Second-degree Type I
• Third-degree
Third degree
Rationale:
Complete heart block causes a decrease in cardiac output with possible periods of syncope (fainting), known as a Stokes-Adams attack. Third degree, or complete atrioventricular (AV) block, occurs when the conduction link between the atria and ventricles is lost, causing the atrial and ventricular rates to be regular but dissociated. Sec degree AV block is characterized by intermittent failure of conduction of one or more impulses from the atria to the ventricles. First-degree AV block is characterized by a prolonged PR interval> 0.20 second).
74
Which cardiac drug classification decreases sympathetic outflow to the heart and is the is the cornerstone of therapy for catecholaminergic polymorphic ventricular tachycardia (CPVT)?
• Beta-adrenergic blockers
• Calcium channel blockers
Potassium blockers
Sodium channel blockers
A. Beta-adrenergic blockers
Rationale:
Antiarrhythmic drugs act by modifying disordered formation and conduction of impulses that induce cardiac muscle contraction. Beta-adrenergic blocking drugs decrease sympathetic outflow to the heart. Antiadrenergic treatment with beta-blockers is the cornerstone of therapy for CPVT. The remaining options act by blocking specific electrolytes, thus altering electrical impulses affecting the heart.
75
Two months following a myocardial infarction (MI), a client visits the health care provider with reports of severe fatigue, shortness of breath, and frequent episodes of palpitations.
A 12-lead ECG reveals the client has atrial fibrillation with a heart rate of 120. Which medications should the health care provider consider prescribing for this client? Select all that apply.
_ Analgesics
Anticoagulants
Antiarrhythmics
Inhalers
Thrombolytics
Anticoagulant and anti arrhythmia
76
Which class of cardiac antiarrhythmic drugs extends the action potential and refractoriness of the heart's contraction?
• Class IV
Class 1
Class 111
Class 11
Class 111
77
The nurse is assisting a client who had a myocardial infarction 2 days ago during a bath. The client suddenly lost consciousness and the nurse was unable to feel a pulse.
Cardiopulmonary resuscitation was begun and the client was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. What is a priority intervention at this time?
• Synchronized cardioversion
•Applying a transcutaneous pacemaker
Administration of atropine
• Immediate defibrillation
Immediate defib
78
Atrial fibrillation is the most common chronic dyshythmia whose incidence increases with age. Atrial fibrillation may present as asymptomatic to severe symptomatology. What is the treatment of atrial fibrillation dependent on? Select all that apply.
A. Etiology
B. Persistence of dysrhythmia
C. Size of pulse deficits
D. Atrial rate
E. Recency of onset
A.B.C.
79
A client who will be undergoing a Holter monitor examination would be given which instruction?
• "Wear clothing that you can exercise in during the test."
• "Lay very still during the procedure for an accurate reading."
• "Keep a diary of your activities and symptoms throughout the examination."
• "You will need to have an intravenous injection prior to the start of the test."
Keep a diary
80
Considering the PQRST complex of an ECG which letter represents atrial depolarization?
ST segment
T wave
P wave
QRS complex
P wave
Qrs- is ventricular depolarization and t wave is repolarization
81
Pharm - chapter 42
1. When describing heart valves to a group of students, which information would the instructor include?
a. The closing of the AV valves is what is solely responsible for heart sounds.
b. Small muscles attached to the AV valves are responsible for opening and closing the valves.
c. The aortic valve opens when the pressure in the left ventricle becomes greater than the aortic pressure.
d. The valves leading to the great vessels are called the cuspid valves.
C. The aortic valve opens when the pressure
82
2. In the heart, the
a. ventricles will not contract unless they are stimulated by action potentials arising from the SA node.
b. fibrillation of the atria will cause blood pressure to fall to zero.
c. absence of nerve stimulation can cause spontaneous depolarization of the muscle membrane.
d. muscle can continue to contract for a long period of time in the absence of oxygen.
C. Absence of nerve stimulation
83
3. The activity of the heart depends on both the inherent properties of the cardiac muscle cells and the activity of the autonomic nerves to the heart. Therefore,
a. cutting all of the autonomic nerves to the heart produces a decrease in resting heart rate.
b. blocking the parasympathetic nerves to the heart decreases the heart rate.
c. stimulating the sympathetic nerves to the heart increases the time available to fill the ventricles during diastole.
d. the heart rate will increase in cases of dehydration, which will lead to less filling time.
D. The heart rate will increase in cases of dehydration, which will lead to less filling time
84
4. A heart transplantation patient has no nerve connections to the transplanted heart. In such a person, one would expect to find
a. a slower-than-normal resting heart rate.
b. atria that contract at a different rate than ventricles.
C. an increase in heart rate during emotional stress.
d. inability to exercise because there is no way to increase heart rate.
An increase in heart rate during emotional stress
85
5. Which is correct regarding the cardiac cycle?
a. Blood that has a high amount of oxygen enters the left atrium.
b. Blood that has a high amount of oxygen enters the right ventricle.
c. The highest pressure is found in the right ventricle of the heart.
d. The mitral valve allows for bidirectional blood flow.
A. High oxygen entering the left atrium
86
6. Cardiac cells differ from skeletal muscle cells in that they
a. contain actin and myosin.
b. possess automaticity and conductivity.
c. require calcium for muscle contraction to occur.
d. do not require oxygen to survive.
B. Possess automaticity and conductivity
87
7. Clinically, dysthythmias, or arrhythmias, may cause
a. altered cardiac output that could affect all cells.
b. changes in capillary filling pressures.
c. alterations in osmotic pressure.
d. valvular dysfunction.
A. Altered cardiac output
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8. A patient is brought to the emergency room with a suspected myocardial infarction. The patient is upset because they had just had an ECG in their provider's office a The explanation of this common phenomenon would include the fact that the ECG
a. only reflects changes in cardiac output.
b. is not a very accurate test.
c. only measures the flow of electrical current through the heart.
d. is not related to the heart problems.
Measures electrical current
C. Only
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9. Blood flow to the myocardium differs from blood flow to the rest of the cells of the body in that blood
a. perfuses the myocardium during systole.
b. flow is determined by many local factors, including buildup of acid.
c. perfuses the myocardium during diastole.
d. that is oxygenated flows to the myocardium via veins.
C. Perfumes myocardium during diastole
90
During diastole, which would occur?
a. Opening of the AV valves
b. Relaxation of the myocardial muscle
c. Flow of blood from the atria to the ventricles
d. Contraction of the ventricles
e. Closing of the semilunar valves
f. Filling of the coronary arteries
ABCEF
91
The sympathetic nervous system would be expected to have which effects?
a. Stimulates the heart to beat faster
b. Speeds conduction through the AV ride
c. Causes the heart muscle to contract harder
d. Slows conduction through the AV node
e. Decreases overall vascular volume
f. Increases total peripheral resistance
ABCF
92
Pharm - chapter 43
1. Baroreceptors are the most important factor in controlling fast changes in BP. Baroreceptors
a. are evenly distributed throughout the body to maintain pressure in the system.
b. sense pressure and immediately send that information to the medulla in the brain.
c. sense changes in neurons and are directly connected to the sympathetic nervous system.
d. sense hemoglobin changes and are as sensitive to oxygen levels as to pressure changes.
B. Sense pressure and send to the brain
93
2. Essential hypertension is the most commonly diagnosed form of high BP. Essential hypertension is
a. caused by a tumor in the adrenal gland.
b. associated with no known cause.
c. related to renal disease.
d. caused by liver dysfunction.
B. No cause
94
3. Hypertension is associated with
a. loss of vision.
b. strokes.
c. atherosclerosis.
d. all of the above.
D. All of above
95
4. The stepped-care approach to the treatment of hypertension includes
a. lifestyle modification, including exercise, diet, and decreased smoking and alcohol intake.
b. use of a diuretic, beta-blocker, or ACE inhibitor to supplement lifestyle changes.
c. a combination of antihypertensive drug classes to achieve desired control.
d. all of the above.
D. All
96
5. ACE inhibitors work on the RAAS to prevent the conversion of angiotensin I to angiotensin II. Because this blocking occurs in the cells in the lung, which is usually the site of this conversion, the use of ACE inhibitors often results in
a. spontaneous pneumothorax.
b. pneumonia.
c. unrelenting cough.
d. respiratory depression.
C. Cough
97
A patient taking an ACE inhibitor is scheduled for surgery. Because this medication may be dangerous in the setting of general anesthesia, the nurse should
a. stop the drug without discussing with the providers.
b. alert the provider caring for the patient and mark the patient's chart prominently.
c. cancel the surgery and consult with the prescriber.
d. monitor fluid levels and make sure the fluids are restricted before surgery.
B. Alert MD
98
7. A patient who is hypertensive becomes pregnant. Which is the safest medication for this patient?
a. Angiotensin Il receptor blocker
b. ACE inhibitor
c. Beta-blocker
d. Calcium-channel blocker
C. Beta blocker
99
8. Droxidopa, an antihypotensive drug, should be used
a. only with patients who are confined to bed.
b. in the treatment of acute shock.
c. in patients with known pheochromocytoma.
d. to treat orthostatic hypotension in patients whose lives are impaired by the disorder.
D. Impaired lives
100
1. Pressure within the vascular system is determined by which?
a. Peripheral resistance
b. Stroke volume
c. Sodium load
d. Heart rate
e. Total intravascular volume
f. Rate of erythropoietin release
ABDE
101
2. The RAAS is associated with which?
a. Intense vasoconstriction and BP elevation
b. Blood flow through the kidneys
c. Production of surfactant in the lungs
d. Release of aldosterone from the adrenal cortex
e. Retention of sodium and water in the kidneys
f. Liver production of fibrinogen
ABDE
102
Pharm - chapter 44
1. A nurse assessing a patient with HF would expect to find
a. cardiac arrest.
b. congestion of blood vessels.
c. an infection.
d. a pulmonary embolism.
B. A congestion of blood vessels
103
2. Calcium is needed in the cardiac muscle to
a. break apart actin-myosin bridges.
b. activate troponin.
c. promote contraction via sliding.
d. maintain the electrical rhythm.
C. Promote contraction
104
3. When assessing a patient with right-sided HF, the nurse would expect to find edema
a. in gravity-dependent areas.
b. in the hands and fingers.
c. around the eyes.
d. when the patient is lying down.
A. In gravity dependent areas
105
4. ACE inhibitors and beta-blockers are used in the treatment of HF to slow the progression of disease. They act to
a. decrease workload on the heart by lowering contractility, preload, and afterload.
b. increase arterial pressure and perfusion.
c. cause pooling of the blood and decreased venous return to the heart.
d. increase the release of aldosterone and improve fluid balance.
A. Decrease workload
106
5. A nurse is preparing to administer a prescribed cardiac glycoside to a patient based on the understanding that this group of drugs acts in which way?
a. They work in the kidneys to increase fluid excretion.
b. They affect renin release in the renin-angiotensin system.
c. They block the parasympathetic influence on the heart muscle.
d. They affect intracellular calcium levels in the heart muscle.
D. Calcium levels in the heart muscle
107
6. A nurse would instruct a patient taking digoxin (Lanoxin) for the treatment of HF to take which action?
a. Make up any missed doses the next day.
b. Report changes in heart rate.
c. Avoid exposure to the sun.
d. Avoid potassium supplemen!s.
B. Report changes in heart rate
108
7. A nurse is about to administer digoxin (Lanoxin) to a patient whose apical pulse is 48 beats/min. The nurse should
a. administer the drug and notify the prescriber that the heart rate is low.
b. retake the pulse in 15 minutes and give the drug if the pulse has not changed.
c. retake the pulse in 1 hour and withhold the drug if the pulse is still less than 60 beats/min.
d. withhold the drug and notify the prescriber that the heart rate is below 60 beats/min.
C. Hold for 1 hour and retake, if less than 60/ hold it
109
8. How does ivabradine (Corlanor) work in the body?
a. Blocks beta-receptors to slow the heart rate
b. Slows influx of calcium to decrease force of contraction
c. Slows influx of calcium and relaxes blood vessels
d. Reduces heart rate by inhibiting action potentials at the SA node
D. Reduces heart rate by inhibiting action potentials on SA node.
110
1. HF occurs when the heart fails to pump effectively. Which could cause HF?
a. Coronary artery disease
b. Chronic hypertension
c. Cardiomyopathy
d. Fluid overload
e. Pneumonia
f. Cinhosis
ABC
111
2. A patient develops left-sided HF fter an MI. Which would the nurse expect to find during the patient assessment?
a. Orthopnea
b. Polyuria
c. Tachypnea
d. Dyspnea
e. Blood-tinged sputum
f. Swollen ankles
ACDE
112
Chapter 45-PHarm
1. Cardiac contraction and relaxation are controlled by
a. a specific area in the brain.
b. the sympathetic nervous system.
c. the autonomic nervous system.
d. an action potential and electrical conduction arising within the heart. -
D.
113
2. Antiarhythmic drugs alter the action potential of the cardiac cells. Because they alter the action potential, antiarrhythmic drugs often cause
a. HF.
b. altered blood flow to the kidney.
c. new arrhythmias.
d. electrolyte disturbances.
C. New arrhythmias
114
3. Lidocaine is a class Ib antiarrhythmic. It primarily blocks
a. potassium influx.
b. beta receptors.
c. calcium influx.
d. sodium influx.
D. Sodium influx
115
4. Ibutilide (Corvert) is a class IlI antiarhythmic drug that is used for
a. sedation during electrocardioversion.
b. conversion of recent-onset AF and flutter.
c. treatment of life-threatening ventricular arrhythmias.
d. treatment of arrhythmias complicated by HF.
B. Conversion of recent onset AF and flutter
116
5. Which of the following is known to have a negative inotropic effect and increase risk of a patient developing heart failure?
a. Digoxin
b. Verapamil
c. Lidocaine
d. Adenosine
B. Verapamil
117
6. A patient who is receiving an antiarhythmic drug needs
a. careful cardiac monitoring until stabilized.
b. frequent blood tests, including drug levels.
c. an antidepressant to deal with psychological depression.
d. dietary changes to prevent irritation of the heart muscle.
A. Cardiac monitoring
118
7. A patient is brought into the emergency room with a potentially life-threatening ventricular arrhythmia. Immediate treatment might include
a. a loading dose of digoxin.
b. injection of quinidine.
c. bolus and titrated doses of lidocaine.
d. loading dose of propafenone
C. Bolus and titrated doses of lidocaine
119
8. A patient stabilized on quinidine for the regulation of AF would be cautioned to avoid foods
a. rich in potassium.
b. containing tyrosine.
c. high in sodium. -
d. that alkalinize the urine.
D. That allalinize the urine
120
1.
The conduction system of the heart includes which structures?
a. SA node
b. Sinuses of Valsalva
c. Atrial bundles
d. Purkinje fibers
e. Coronary sinus
f. Bundle of His
ACDF
121
2.
Arrhythmias or dysrhythmias can be caused by which situations?
a. Lack of oxygen to the heart muscle cells
b. Acidosis near a cell
c. Structural damage in the conduction path way through the heart
d. Vasodilation in the myocardial vascular bed
e. Thyroid hormone imbalance
f. Electrolyte imbalances
ABCEF
122
Pharm- chapter 46
1. Coronary artery disease results in
a, an imbalance in cardiac muscle oxygen supply and demand.
b. delivery of blood to the heart muscle during systole.
c. Increased pulse pressure.
d. a decreased workload on the heart.
A. An imbalance in cardiac muscle oxygen supply and demand
123
2. Angina
a, causes death of heart muscle cells.
b. is pain due to lack of oxygen to myocardial cells, c, cannot occur at rest.
d. is not treatable.
B. Pain due to lack of oxygen to cells
124
3. Nitrates are commonly used antianginal drugs that act to
a. Increase the preload on the heart. b, Increase the afterload on the heart.
c. dilate coronary vessels to increase the delivery of oxygen through those vessels.
d. decrease venous return to the heart, decreasing the myocardial workload.
D. Decrease venous return
125
4, Calcium channel blockers are effective in treating angina because they
a. prevent any CV exercise, preventing strain on the heart.
b. block strong muscle contractions, causing vasodilation.
c. alter the electrolyte balance of the heart, preventing arrhythmias.
d. increase the heart rate, making it more efficient.
B. Block strong muscle contractions
126
5. A nurse would recognize that increased monitoring would be recommended if a patient was taking both verapamil and which medication?
a. Oral contraceptives
b. Cyclosporine
c. Digoxin
d. Barbiturate anesthetics
D. Barbiturate anesthetic
127
Prinzmetal angina occurs as a result of
a. electrolyte imbalance.
b. a spasm of a coronary vessel.
c. decreased venous return to the heart.
d. a ventricular arrhythmia.
B. A spasm
128
Treating angina involves modifying factors that could decrease myocardial oxygen consumption. It could be expected that this might include
a. weight loss.
b. use of nitrates.
c. use of angiotensin-converting enzyme inhibitors.
d. activity modification.
e. use of a piperazine acetamide agent.
f. use of a calcium channel blocker.
ABDef
129
An acute myocardial infarction is usually associated with which conditions?
a. Permanent injury to the heart muscle
b. Potentially serious arrhythmias
c. Pain
d. The development of hypertension
e. Loss of consciousness
I. A feeling of anxiety
ABCF
130
When describing the action of antianginal drugs to a patient, which would the nurse include?
a. Decrease the workload on the heart
b. Increase the supply of oxygen to the heart
c. Change the metabolic pathway in the heart muscle to remove the need for oxygen
d. Restore the supply-and-demand balance of oxygen in the heart
e. Decrease venous return to the heart
I. Alter the coronary artery filling pathway
ABDE
131
4. A client who has nitroglycerin to avert an acute anginal attack would need to be taught to
a. take five or six tablets and then seek medical help if no relief occurs.
b. buy the tablets in bulk to decrease the cost.
c. protect tablets from light and humidity.
d. store the tablets in a clearly marked, clear container in open view.
e. use the nitroglycerin before an event or activity that will most likely precipitate an anginal attack.
f. discard them if they do not fizzle when placed under the tongue.
CEF
132
Pharm - chapter 47
1. Which of the following descriptions accurately reflects how the body uses cholesterol?
a. Production of water-soluble vitamins
b. Formation of steroid hormones
c. Mineralization of bones
d. Development of dental plaques
B. Formation of steroid hormones
133
2. The formation of atheronas in blood vessels precedes the signs and symptoms of
a, hepatitis,
b. atherosclerotic cardiovascular disease,
c. diabetes mellitus.
d. chronic obstructive pulmonary disease (COPD).
B.
134
3. Hyperlipidemia is considered to be a a, normal finding in adult males,
b. condition related to stress levels.
c. treatable ASCVD risk factor.
d. side effect of cigarette smoking.
C. Treatable
135
4. The bile acid sequestrants
a. are absorbed into the liver.
b. take several weeks to show an effect.
c. have no associated adverse effects, d, prevent bile salts from being reabsorbed.
D. Prevent bile salts from being absorbed
136
5. HMG-CoA reductase inhibitors work in the
a. process of bile secretion.
b. process of cholesterol formation in the cell.
c. intestinal wall to block fat absorption.
d. kidney to block fat excretion.
B. Cholesterol formation in the cell
137
6. When teaching a patient about HMG-CoA reductase inhibitors, the nurse would include that the patient
a. will not have a heart attack.
b. will not develop ASCVD.
c. might develop cataracts as a result.
d. might stop absorbing fat-soluble vitamins.
C. Might develop cataracts
138
7. Which would the nurse expect the health care provider to prescribe for a patient who has high lipid levels and cannot take fibrates or HMG COA reductase inhibitors?
a. Nicotine
b. Vitamin C
c. PCSK9 inhibitor
d. Nitrates
C. Pcsk9 inhibitor
139
8. Which would alert the nurse to suspect that a patient receiving HMG-CoA reductase inhibitors is developing rhabdomyolysis?
a. Flatulence and abdominal bloating
b. Increased bleeding and bruising
c. Development of cataracts and blurred vision
d. Muscle pain and weakness
D. Pain and weakness
140
1. A bile acid sequestrant is the drug of choice for a patient who has which conditions?
a. High LDL concentration
b. High triglyceride concentration
c. Biliary obstruction
d. Vitamin K deficiency
e. High HDL concentration
f. Intolerance to statins
AF
141
2. Teaching a patient who is prescribed an HMG-CoA reductase inhibitor to treat high cholesterol and high lipid levels should include which information?
a. The importance of exercise
b. The need for dietary changes to alter cholesterol levels
c. That taking a statin will allow a full, unrestricted diet
d. That drug therapy is always needed when these levels are elevated
e. The importance of controlling bipod pressure and blood glucose levels
f. That stopping smoking may also help to lower lipid levels
ABEF
142
The patient returns from the postanesthesia care unit (PACU) with the following order: morphine 3 mg IV every 2 hours as needed for relief of pain. The vial reads morphine, 4 mg/m. How many milliiters of morphine will the nurse administer?
a) 1 mL
b) 0.75 mL
c) 0.5 mL
d) 0.25 mL
0.75ml
143
The nurse is caring for a pediatric patient who has been diagnosed with paroxysmal atrial tachycardia. The order reads digoxin 10 mcg/kg orally. The child weighs 44 pounds. How many mcg will the nurse administer?
a) 50 mcg
b) 100 mcg
c) 150 mcg
d) 200 mcg
D)200
144
The physician prescribes 250 mg of a drug. The information on the drug vial says the concentration is 500 mg/mL.
12>
A. O.33
B. 0.25
C. 0.5
D. 0.75
O.5
