CARDIOVASCULAR DISORDER

1. Which of the following arteries primarily feeds the anterior wall of the heart? 1. Circumflex artery 2. Internal mammary artery 3. Left anterior descending artery 4. Right coronary artery 1.3. The left anterior descending artery is the primary source of blood for the anterior wall of the heart. The circumflex artery supplies the lateral wall, the internal mammary artery supplies the mammary, and the right coronary artery supplies the inferior wall of the heart. 2. When do coronary arteries primarily receive blood flow? 1. During cardiac standstill 2. During diastole 3. During expiration 4. During systole 2.2. Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. Blood doesn't flow during cardiac standstill. Breathing patterns are irrelevant to blood flow. 3. Which of the following illnesses is the leading cause of death in the United States? 1. Cancer 2. Coronary artery disease 3. Liver failure 4. Renal failure 3.2. Coronary artery disease accounts for over 50% of all deaths in the United States. Cancer accounts for approximately 20%. Liver failure and renal failure account for less than 10% of all deaths in the United States. 4. Which of the following conditions most commonly results in coronary artery disease (CAD)? 1. Atherosclerosis 2. Diabetes mellitus 3. Myocardial infarction 4. Renal failure 4.1. Atherosclerosis, or plaque formation, is the 1 leading cause of CAD. Diabetes mellitus is a risk factor for CAD but it isn't the most common cause. Renal failure doesn't cause CAD, but the two conditions are related. Myocardial infarction is commonly a result of CAD. 5. Atherosclerosis impedes coronary blood flow by which of the following mechanisms? 1. Plaques obstruct the vein 2. Plaques obstruct the artery 3. Blood clots form outside the vessel wall 4. Hardened vessels dilate to allow blood to flow through 5.2. Arteries, not veins, provide coronary blood flow. Atherosclerosis is a direct result of plaque formation in the artery. Hardened vessels can't dilate properly and, therefore, constrict blood flow. 6. Which of the following risk factors for coronary artery disease cannot be corrected? 1. Cigarette smoking 2. Diabetes mellitus 3. Heredity 4. Hypertension 6. 3. Because "heredity" refers to our genetic makeup, it can't be changed. Cigarette smoking cessation is a lifestyle change that involves behavior modification. Diabetes mellitus is a risk factor that can be controlled with medication. Altering one's diet, exercise, and medication can correct hypertension. 7. Exceeding which of the following serum cholesterol levels significantly increases the risk of coronary artery disease? 1. 100 mg/di 2. 150 mg/dl 3.175 mg/di 4. 200 mg/dl 7. 4. Cholesterol levels above 200 mg/dl are considered excessive. They require dietary restriction and perhaps medication. The other levels listed are all below the nationally accepted levels for cholesterol and carry a lesser risk for coronary artery disease. 8. Which of the following actions is the first priority

of care for a client exhibiting signs and symptoms of coronary artery disease? 1. Decrease anxiety. 2. Enhance myocardial oxygenation 3. Administer sublingnal nitroglycerin. 4. Educate the client about his symptoms. 8. 2. Enhancing myocardial oxygenation is always the first priority when a client exhibits signs or symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage. Sublingnal nitroglycerin dilates the coronary vessels to increase blood flow, but its administration isn't the first priority. Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised. 9. Medical treatment of coronary artery disease includes which of the following procedures? 1. Cardiac catheterization 2. Coronary artery bypass surgery 3. Oral medication administration 4. Percutaneous transluminal coronary angioplasty 9. 3. Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Cardiac catheterization isn't a treatment but a diagnostic tool. Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments. 10. Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart? 1. Anterior 2. Apical 3. Inferior 4. Lateral 10. 3. The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, prolonged occlusion could produce an infarction in that area. The right coronary artery doesn't supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left atrium), or the apical portion (left ventricle) of the heart. 11. Which of the following is the most common symptom of myocardial infarction (MI) ? 2

1. Chest pain 2. Dyspnea 3. Edema 4. Palpitations 11.1. The most common Symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output, producing arrhythmias. 12. Which of the following landmarks is the correct one for obtaining an apical pulse? 1. Left fifth intercostal space, midaxillary line 2. Left fifth intercostal space, midclavicular line 3. Left second intercostal space, midclavicular line 4. Left seventh intercostal space, midclavicular line 12.2. The correct landmark for obtaining an apical pulse is the left fifth intercostal space in the midclavicular line. This is the point of maximum impulse and the location of the left ventricle. The left second intercostal space in the midclavicular line is where pulmonic sounds are auscultated. Normally, heart sounds aren't heard in the midaxillary line or the seventh intercostal space in the midclavicular line. 13. Which of the following systems is the most likely origin of pain the client describes as knifelike chest pain that increases in intensity with inspiration? 1. Cardiac 2. Gastrointestinal 3. Musculoskeletal 4. Pulmonary 13. 4. Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increases with movement. Cardiac and GI pains don't change with respiration. 14. A murmur is heard at the second left intercostal space along the left sternal border. Which valve area is this? 1. Aortic 2. Mitral 3. Pulmonic 4. Tricuspid 14. 3. Abnormalities of the pulmonic valve are

auscultated at the second left intercostal space along the left sternal border. Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Tricuspid valve abnormalities are heard at the third and fourth intercostal spaces along the sternal border. 15. Which of the following blood tests is most indicative of cardiac damage? 1. Arterial blood gas (ABG) levels 2. Complete blood count (CBC) 3. Complete chemistry 4. Creatine kinase isoenzymes (CK-MB) 15. 4. CK-MB enzymes are present in the blood after a myocardial infarction. These enzymes spill into the plasma when cardiac tissue is damaged. ABG levels are obtained to review respiratory function, a CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. 16. What is the primary reason for administering morphine to a client with a myocardial infarction? 1. To sedate the client 2. To decrease the client's pain 3. To decrease the client's anxiety 4. To decrease oxygen demand on the client's heart 16. 4. Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and anxiety while causing sedation, but it isn't primarily given for those reasons. 17. Which of the following conditions is most commonly responsible for myocardial infarction (MD? 1. Aneurysm 2. Heart failure 3. Coronary artery thrombosis 4. Renal failure 17. 3. Coronary artery thrombosis causes an occlusion of the artery, leading to myocardial death. An aneurysm is an outpouching of a vessel and doesn't cause an MI. Renal failure can be associated with MI but isn't a direct cause. Heart failure is usually the result of an MI. 18. What supplemental medication is most frequently ordered in conjunction with furosemide (Lasix)? 3

1. Chloride 2. Digoxin 3. Potassium 4. Sodium 18. 3. Supplemental potassium is given with furosemide because of the potassium loss that occurs as a result of this diuretic. Chloride and sodium aren't lost during diuresis. Digoxin acts to increase contractility but isn't given routinely with furosemide. 19. After a myocardial infarction, serum glucose levels and free fatty acid production both increase. What type of physiologic changes are these? 1. Electrophysiologic 2. Hematologic 3. Mechanical 4. Metabolic 19. 4. Both glucose and fatty acids are metabolites whose levels increase after a myocardial infarction. Mechanical changes are those that affect the pumping action of the heart, and electrophysiologic changes affect conduction. Hematologic changes would affect the blood. 20. Which of the following complications is indicated by a third heart sound (S3)? 1. Ventricular dilation 2. Systemic hypertension 3. Aortic valve malfunction 4. Increased atrial contractions 20. 1. Rapid filling of the ventricle causes vasodilation that is auscultated as S3. Increased atrial contraction or systemic hypertension can result in S4. Aortic valve malfunction is heard as a murmur. 21. After an anterior wail myocardial infarction (MI), which of the following problems is indicated by auscultation of crackles in the lungs? 1. Left-sided heart failure 2. Pulmonic valve malfunction 3. Right-sided heart failure 4. Tricuspid valve malfunction 21.1. The left ventricle is responsible for most of the cardiac output. An anterior wall MI may result in a decrease in left ventricular function. When the left ventricle doesn't function properly, resulting in leftsided heart failure, fluid accumulates in the interstitial

and alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve malfunction causes right-sided heart failure. 22. Which of the following diagnostic tools is most commonly used to determine myocardial damage? 1. Cardiac catheterization 2. Cardiac enzymes 3. Echocardiogram 4. Electrocardiogram (ECG) 22.4. The ECG is the quickest, most accurate, and most widely Used tool to diagnose myocardial infarction (MI). Cardiac enzymes also are used to diagnose MI, but the results can't be obtained as quickly and generally aren't as accurate as an ECG. An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catheterization is an invasive study for determining coronary artery disease that can also be used to treat the disease. 23. what is the first intervention for a client experiencing myocardial infarction (MI)? 1. Administer morphine. 2. Administer oxygen. 3. Administer sublingnal nitroglycerin. 4. Obtain an electrocardiogram (ECG). 23. 2. Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. Morphine and sublinguai nitroglycerin are also used to treat MI but they're more commonly administered after the oxygen. An ECG is the most common diagnostic tool used to evaluate MI. 24. What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying? 1. "Tell me about your feelings right now." 2. "When the doctor arrives, everything will be fine." 3. "This is a bad situation, but you'll feel better soon." 4. "Please be assured we're doing everything we can to make you feel better." 24. 1. Validation of a client's feelings is the most appropriate response. It gives the client a feeling of 4

comfort and safety. The other three responses give the client false hope. No one can determine if a client experiencing a myocardial infarction will feel or get better and, therefore, these responses are inappropriate. 25. Which of the following classes of medications protects the ischemic myocardinm by increasing catecholamines and sympathetic nerve stimulation? 1. Beta-adrenergic blockers 2. Calcium channel blockers 3. Narcotics 4. Nitrates 25. 1. Beta-adrenergic blockers work by increasing catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart. Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption and decrease the risk of ventricular arrhythmias. 26. What is the most common complication of a myocardial infarction (MI)? 1. Cardiogenic shock 2. Heart failure 3. Arrhythmias 4. Pericarditis 26. 3. Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI. Cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. The condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results from a bacterial or viral infection. 27. With which of the following disorders is jugular vein distention most prominent? 1. Abdominal aortic aneurysm 2. Heart failure 3. Myocardial infarction (MD 4. Pneumothorax

27. 2. Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. This symptom isn't a symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough, can progress to heart failure; however, in and of itself, an MI doesn't cause jugular vein distention. 28. What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein distention? 1. High Fowler's 2. Raised 10 degrees 3. Raised 30 degrees 4. Supine position 28. 3. Jugular venous pressure is measured with a centimeter ruler to obtain the vertical distance between the sternal angle and the point of highest pulsation with the head of the bed inclined between 15 and 30 degrees. Increased pressure can't be seen when the client is supine or when the head of the bed is raised 10 degrees because the point that marks the pressure level is above the jaw (therefore, not visible). In high Fowier's position, the veins would be barely discernible above the clavicle. 29. Which of the following parameters should be checked before administering digoxin? 1. Apical pulse 2. Blood pressure 3. Radial pulse 4. Respiratory rate 29. 1. An apical pulse is essential for accurately assessing the client's heart rate before administering digoxin. The apical pulse is the most accurate pulse point in the body. Blood pressure is usually only affected ff the heart rate is too low, in which case the nurse would withhold digoxin. The radial pulse can be affected by cardiac and vascular disease and, therefore, won't always accurately depict the heart rate. Digoxin has no effect on respiratory function. 30. Toxicity from which of the following medications may cause a client to see a green halo around lights? 1. Digoxin 2. Furosemide (Lasix) 3. Metoprolol (Lopressor) 4. Enalapril (Vasotec) 5

30. 1. One of the most common signs of digoxin toxicity is the visual disturbance known as the green halo sign. The other medications aren't associated with such an effect. 31. Which of the following symptoms is most commonly associated with left-sided heart failure? 1. Crackles 2. Arrhythmias 3. Hepatic engorgement 4. Hypotension 31. 1. Crackles in the lungs are a classic sign of leftsided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be associated with both right- and left-sided heart failure. Hepatic engorgement is associated with rightsided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system. 32. In which of the following disorders would the nurse expect to assess sacral edema in a bedridden client? 1. Diabetes mellitus 2. Pulmonary emboli 3. Renal failure 4. Right-sided heart failure 32. 4. The most accurate area on the body to assess dependent edema in a bedridden client is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure. Diabetes mellitus, pulmonary emboli, and renal disease aren't directly linked to sacral edema. 33. Which of the following symptoms may a client with right-sided heart failure exhibit? 1. Adequate urine output 2. Polyuria 3. Oliguria 4. Polydipsia 33. 3. Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Adequate urine output, polyuria, and polydipsia aren't associated with right-sided heart failure. 34. Which of the following classes of medications maximizes cardiac performance in clients with heart

failure by increasing ventricular contractility? 1. Beta-adrenergic blockers 2. Calcium channel blockers 3. Diuretics 4. Inotropic agents 34. 4. Inotropic agents are administered to increase the force of the heart's contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output. Beta adrenergic blockers and calcium channel blockers decrease the heart rate and ultimately decrease the workload of the heart. Diuretics are administered to decrease the overall vascular volume, also decreasing the workload of the heart. 35. Stimulation of the sympathetic nervous system produces which of the following responses? 1. Bradycardia 2. Tachycardia 3. Hypotension 4. Decreased myocardial contractility 35. 2. Stimulation of the sympathetic nervous system causes tachycardia, or an increase in heart rate. This response causes an increase in contractility, which compensates for the response. The other symptoms listed are related to the parasympathetic nervous system, which is responsible for slowing the heart rate. 36. Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output? 1. Angina pectoris 2. Cardiomyopathy 3. Left-sided heart failure 4. Right-sided heart failure 36. 4. Weight gain, nausea, and a decrease in urine output are secondary effects of right sided heart failure. Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn't cause weight gain, nausea, or a decrease in urine output. 37. What is the most common cause of an abdominal aortic aneurysm? 1. Atherosclerosis 6

2. Diabetes mellitus 3. Hypertension 4. Syphilis 37. 1. Atherosclerosis accounts for 75% of all abdominal aortic aneurysms. Plaques build up on the wall of the vessel and weaken it, causing an aneurysm. Although the other conditions are related to the development of aneurysm, none is a direct cause. 38. In which of the following areas is an abdominal aortic aneurysm most commonly located? 1. Distal to the iliac arteries 2. Distal to the renal arteries 3. Adjacent to the aortic arch 4. Proximal to the renal arteries 38. 2. The portion of the aorta distal to the renal arteries is more prone to an aneurysm because the vessel isn't surrounded by stable structures, unlike the proximal portion of the aorta. Distal to the iliac arteries, the vessel is again surrounded by stable vasculature, making this an uncommon site for an aneurysm. There is no area adjacent to the aortic arch, which bends into the thoracic (descending) aorta. 39. A pulsating abdominal mass usually indicates which of the following conditions? 1. Abdominal aortic aneurysm 2. Enlarged spleen 3. Gastric distention 4. Gastritis 39. 1. The presence of a pulsating mass in the abdomen is an abnormal finding, usually indicaring an outpouching in a weakened vessel, as in abdominal aortic aneurysm. The finding, however, can be normal on a thin person. Neither an enlarged spleen, gastritis, nor gastric distention cause pulsation. 40. What is the most common symptom in a client with abdominal aortic aneurysm? 1. Abdominal pain 2. Diaphoresis 3. Headache 4. Upper back pain 40. 1. Abdominal pain in a client with an abdominal aortic aneurysm results from the disruption of normal circulation in the abdominal region. Lower back pain, not upper, is a common symptom, usually signifying

expansion and impending rupture of the aneurysm. Headache and diaphoresis aren't associated with abdominal aortic aneurysm. 41. Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm? 1. Abdominal pain 2. Absent pedal pulses 3. Angina 4. Lower back pain 41.4. Lower back pain results from expansion of the aneurysm. The expansion applies pressure in the abdominal cavity, and the pain is referred to the lower back. Abdominal pain is the most common symptom resulting from impaired circulation. Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease. Angina is associated with atherosclerosis of the coronary arteries. 42. What is the definitive test used to diagnose an abdominal aortic aneurysm? 1. Abdominal X-ray 2. Arteriogram 3. Computed tomography (CT) scan 4. Ultrasound 42. 2. An arteriogram accurately and directly depicts the vasculature; therefore, it dearly delineates the vessels and any abnormalities. An abdominal aneurysm would only be visible on an X-ray if it were calcified. CT scan and ultrasound don't give a direct view of the vessels and don't yield as accurate a diagnosis as the arteriogram. 43. Which of the following complications is of greatest concern when caring for a preoperative abdominal aortic aneurysm client? 1. Hypertension 2. Aneurysm rupture 3. Cardiac arrhythmias 4. Diminished pedal pulses 43.2. Rupture of the aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this type of client. Hypertension should be avoided and controlled because it can cause the weakened vessel to rupture. Diminished pedal pulses, 7

a sign of poor circulation to the lower extremities, are associated with an aneurysm but aren't lifethreatening. Cardiac arrhythmias aren't directly linked to an aneurysm. 44. Which of the following blood vessel layers may be damaged in a client with an aneurysm? 1. Externa 2. Interna 3. Media 4. Interna and media 44. 3. The factor common to all types of aneurysms is a damaged media. The media has more smooth muscle and less elastic fibers, so it's more capable of vasoconstriction and vasodilation. The interna and externa are generally not damaged in an aneurysm. 45. When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated? 1. Right upper quadrant 2. Directly over the umbilicus 3. Middle lower abdomen to the left of the midline 4. Middle lower abdomen to the right of the midline 45. 3. The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation. 46. Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms? 1. Diabetes mellitus 2. Hypertension 3. Peripheral vascular disease 4. Syphilis 46. 2. Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur. Atherosclerotic changes can occur with peripheral vascular diseases and are linked to aneurysms, but the link isn't as strong as it is with hypertension. Only 1% of clients with syphilis experience an aneurysm. Diabetes mellitus doesn't have a direct link to aneurysm. 47. Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client? 1. Bruit

2. Crackles 3. Dullness 4. Friction rubs 47. 1. A bruit, a vascular sound resembling heart murmur, suggests partial arterial occlusion. Crackles are indicative of fluid in the lungs. Dullness is heard over solid organs, such as the liver. Friction rubs indicate inflammation of the peritoneal surface. 48. Which of the following groups of symptoms indicates a ruptured abdominal aortic aneurysm? 1. Lower back pain, increased blood pressure, decreased red blood cell (RBC) count, increased white blood cell (WBC) count 2. Severe lower back pain, decreased blood pressure, decreased RBC count, increased WBC count 3. Severe lower back pain, decreased blood pressure, decreased RBC count, decreased WBC count 4. Intermittent lower back pain, decreased blood pressure, decreased RBC count, increased WBC count 48. 2. Severe lower back pain indicates an aneurysm rupture, secondary to pressure being, applied within the abdominal cavity. When rupture occurs, the pain is constant because it can't be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn't increase. For the same reason, the RBC count is decreased not increased. The WBC count increases as cells migrate to the site of injury. 49. Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area? 1. Hernia 2. Stage 1 pressure ulcer 3. Retroperitoneal rupture at the repair site 4. Rapid expansion of the aneurysm 49. 3. Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal area. This rupture is most commonly caused by leakage at the repair site. A hernia doesn't cause vascular disturbances, nor does a pressure ulcer. Because no bleeding occurs with rapid expansion of the aneurysm, 8

a hematoma won't form. 50. Which hereditary disease is most closely linked to aneurysm? 1. Cystic fibrosis 2. Lupus erythematosus 3. Marfan's syndrome 4. Myocardial infarction 50. 3. Marfan's syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore, clients with the syndrome are more likely to develop an aneurysm. Although cystic fibrosis is hereditary, it hasn't been linked to aneurysms. Lupus erythematosus isn't hereditary. Myocardial infarction is neither hereditary nor a disease. 51. Which of the following treatments is the definitive one for a ruptured aneurysm? 1. Antihypertensive medication administration 2. Aortogram 3. Beta-adrenergic blocker administration 4. Surgical intervention 51.4. When the vessel ruptures, surgery is the only intervention that can repair it. Administration of antihypertensive medications and beta-adrenergic blockers can help control hypertension, reducing the risk of rupture. An aortogram is a diagnostic tool used to detect an aneurysm. 52. Which of the following heart muscle diseases is unrelated to other cardiovascular disease? 1. Cardiomyopathy 2. Coronary artery disease 3. Myocardial infarction 4. Pericardial effusion 52. 1. Cardiomyopathy isn't usually related to an underlying heart disease such as atherosclerosis. The etiology in most cases is unknown. Coronary artery disease and myocardial infarction are directly related to atherosclerosis. Pericardial effusion is the escape of fluid into the pericardial sac, a condition associated with pericarditis and advanced heart failure. 53. Which of the following types of cardiomyopathy can be associated with childbirth? 1. Dilated 2. Hypertrophic 3. Myocarditis

4. Restrictive 53. 1. Although the cause isn't entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy or the first few months after birth. The condition may result from a preexisting cardiomyopathy not apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. Myocarditis isn't specifically associated with childbirth. Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial. 54. Septal involvement occurs in which type of cardiomyopathy? 1. Congestive 2. Dilated 3. Hypertrophic 4. Restrictive 54. 3. In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum not the ventricle chambers is apparent. This abnormality isn't seen in other types of cardiomyopathy. 55. Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy? 1. Heart failure 2. Diabetes mellitus 3. Myocardial infarction 4. Pericardial effusion 55. 1. Because the structure and function of the heart muscle is affected, heart failure most commonly occurs in clients with cardiomyopathy. Myocardial infarction results from atherosclerosis. Pericardial effusion is most predominant in clients with pericarditis. Diabetes mellitus is unrelated to cardiomyopathy. 56. What is the term used to describe an enlargement of the heart muscle? 1. Cardiomegaly 2. Cardiomyopathy 3. Myocarditis 4. Pericarditis 56. 1. Cardiomegaly denotes an enlarged heart muscle. Cardiomyopathy is a heart muscle disease of unknown origin. Myocarditis refers to inflammation 9

of heart muscle, rather than enlargement of the muscle itself. Pericarditis is an inflammation of the pericardium, the sac surrounding the heart, and isn't associated with heart muscle enlargement. 57. Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following conditions? 1. Pericarditis 2. Hypertension 3. Myocardial infarction 4. Heart failure 57. 4. These are the classic symptoms of heart failure, the most common problem related to cardiomyopathy. Pericarditis is exhibited by a feeling of fullness in the chest and auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual disturbances, and a flushed face. Myocardial infarction causes heart failure but isn't related to these symptoms. 58. In which of the following types of cardiomyopathy does cardiac output remain normal? 1. Dilated 2. Hypertrophic 3. Obliterative 4. Restrictive 58. 2. Cardiac output isn't affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. Dilated cardiomyopathy, obliterative cardiomyopathy, and restrictive cardiomyopathy all decrease cardiac output. 59. Which of the following cardiac conditions does an S4 heart sound indicate? 1. Dilated aorta 2. Normally functioning heart 3. Decreased myocardial contractility 4. Failure of the ventricle to eject all the blood during systole 59. 4. An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. This increased resistance is related to decreased compliance of the ventricle. A dilated aorta doesn't cause an extra heart sound, though it does cause a murmur. Decreased myocardial contractility is heard as an S3 heart sound. An S4 isn't heard in a normally

functioning heart. 60. Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy? 1. Antihypertensives 2. Beta-adrenergic blockers 3. Calcium channel blockers 4. Nitrates 60. 2. By decreasing the heart rate and contractility, beta-adrenergic blockers improve myocardial filling and cardiac output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren't usually indicated, because they would decrease cardiac output in clients who are often already hypotensive. Calcium channel blockers are sometimes used for the same reasons as beta-adrenergic blockers; however, they aren't as effective as beta-adrenergic blockers and cause increased hypotension. Nitrates aren't used because of their dilating effects, which would further compromise the myocardium. 61. If medical treatments fail, which of the following invasive procedures is necessary for treating cardiomyopathy? 1. Cardiac catheterization 2. Coronary artery bypass graft (CABG) 3. Heart transplantation 4. Intra-aortic balloon pump (IABP) 61.3. The only definitive treatment for cardiomyopathy that can't be controlled medically is a heart transplant because the damage to the heart muscle is irreversible. Cardiac catheterization is an invasive diagnostic procedure for coronary artery disease. CABG is a surgical intervention used for atherosclerotic vessels. An IABP is an invasive treatment that assists the failing heart; however, it can't be used for an extended time, because it's only a temporary solution. 62. Which of the following conditions is associated with a predictable level of pain that occurs as a result of physical or emotional stress? 1. Anxiety 2. Stable angina 3. Unstable angina 4. Variant angina 62. 2. The pain of stable angina is predictable in 10

nature,

builds

gradually,

and

quickly

reaches

maximum intensity. Anxiety generally isn't described as painful. Unstable angina doesn't always need a trigger, is more intense, and lasts longer than stable angina. Variant angina usually occurs at rest -- not as a result of exertion or stress. 63. After undergoing a cardiac catheterization, the client has a large puddle of blood under his buttocks. Which of the following steps should the nurse take first? 1. Call for help. 2. Obtain vital signs. 3. Ask the client to "lift up." 4. Apply gloves and assess the groin site. 63.4. Observing standard precautions is the first priority when dealing with any body fluid. Assessment of the groin site is the second priority. This establishes where the blood is coming from and determines how much blood has been lost. The goal in this situation is to stop the bleeding. The nurse would call for help if it were warranted after the assessment of the situation. After determining the extent of the bleeding, vital signs assessment is important. The nurse should never move the client, in case a clot has formed. Moving can disturb the clot and cause rebleeding. 64. Which of the following types of pain is most characteristic of angina? 1. Knifelike 2. Sharp 3. Shooting 4. Tightness 64. 4. The pain of angina usually ranges from a vague feeling of tightness to heavy, intense pain. Pain impulses originate in the most visceral muscles and may move to such areas as the chest, neck, and arms. Pain described as knifelike, sharp, or shooting is more characteristic of pulmonary or pleuritic pain. 65. Which of the following types of angina is most closely associated with an impending myocardial infarction (MI)? 1. Angina decubitus 2. Chronic stable angina 3. Nocturnal angina 4. Unstable angina

65. 4. Unstable angina progressively increases in frequency, intensity, and duration and is related to an increased risk of MI within 3 to 18 months. Angina decubitus, chronic stable angina, and nocturnal angina aren't associated with an increased risk of MI. 66. Which of the following medications is the drug of choice for angina pectoris? 1. Aspirin 2. Furosemide (Lasix) 3. Nitroglycerin 4. Nifedipine (Procardia) 66. 3. Nitroglycerin is administered to reduce the myocardial demand, which decreases ischemia and relieves pain. In addition, nitroglycerin dilates the vasculature, thereby reducing preload. Aspirin is administered to reduce clot formation in clients having a myocardial infarction. Furosemide is a loop diuretic that won't directly reduce pain. Nifedipine is a calcium channel blocker primarily used to decrease coronary artery spasm, as in variant angina. 67. Which of the following conditions is the predominant cause of angina? 1. Increased preload 2. Decreased afterload 3. Coronary artery spasm 4. Inadequate oxygen supply to the myocardium 67. 4. Inadequate oxygen supply to the myocardium is responsible for the pain accompanying angina. Increased preload would be responsible for right-sided heart failure. Decreased afterload causes low cardiac output. Coronary artery spasm is responsible for variant angina. 68. Which of the following tests is used most often to diagnose angina? 1. Chest X-ray 2. Echocardiogram 3. Cardiac catheterization 4. 12-lead electrocardiogram (ECG) 68. 4. The 12-lead ECG will indicate ischemia, showing T-wave inversion. In addition, with variant angina, the ECG shows ST-segment elevation. A chest X-ray will show heart enlargement or signs of heart failure but isn't used to diagnose angina. An echocardiogram is used to detect wall function and 11

valvular function and is most accurate in diagnosing myocardial infarction. Cardiac catheterization is used to diagnosis coronary artery disease, which can cause angina. 69. Which of the following results is the primary treatment goal for angina? 1. Reversal of ischemia 2. Reversal of infarction 3. Reduction of stress and anxiety 4. Reduction of associated risk factors 69. 1. Reversal of the ischemia is the primary goal, achieved by reducing oxygen consumption and increasing oxygen supply. An infarction is permanent and can't be reversed. Reduction of associated risk factors, such as stress and anxiety, is a progressive, long-term treatment goal that has cumulative effects. Reduction of these factors will decrease the risk for angina but this usually isn't an immediate goal. 70. Which of the following treatments is a suitable surgical intervention for unstable angina? 1. Cardiac catheterization 2. Echocardiogram 3. Nitroglycerin 4. Percutaneous transluminal coronary angioplasty (PTCA) 70. 4. PTCA can alleviate the blockage and restore blood flow and oxygenation. An echocardiogram is a noninvasive diagnostic test. Nitroglycerin is an oral medication. Cardiac catheterization is a diagnostic tool not a treatment. 71. Which of the following interventions should be the first priority when treating a client experiencing chest pain while walking? 1. Sit the client down. 2. Get the client back to bed. 3. Obtain an electrocardiogram (ECG). 4. Administer sublingual nitroglycerin. 71.1. The initial priority is to decrease the oxygen consumption; this would be achieved by sitting the client down. An ECG can be obtained after the client is sitting down. After the ECG, sublingual nitroglycerin would be administered. When the client's condition is stabilized, he can be returned to bed.

72. Which of the following terms is used to describe reduced cardiac output and perfusion impairment clue to ineffective pumping of the heart? 1. Anaphylactic shock 2. Cardiogenic shock 3. Distributive shock 4. Myocardial infarction (MI) 72.2. Cardiogenic shock is shock related to ineffective pumping of the heart. Anaphylactic shock results from an allergic reaction. Distributive shock results from changes in the intravascular volume distribution and is usually associated with increased cardiac output. MI isn't a shock state, though a severe MI can lead to shock. 73. Which of the following conditions most commonly causes cardiogenic shock? 1. Acute myocardial infarction (MD 2. Coronary artery disease 3. Decreased hemoglobin level 4. Hypotension 73. 1. Of all clients with an acute MI, 15% suffer cardiogenic shock secondary to the myocardial damage and decreased function. Coronary artery disease causes MI. Hypotension is the result of a reduced cardiac output produced by the shock state. A decreased hemoglobin level is a result of bleeding. 74. Which of the following percentages represents the amount of damage the myocardium must sustain before signs and symptoms of cardiogenic shock develop? 1.10% 2.25% 3.40% 4.90% 74. 3. At least 40% of the heart muscle must be involved for cardiogenic shock to develop. In most circumstances, the heart can compensate for up to 25% damage. An infarction involving 90% of the heart would result in death. 75. Myocardial oxygen consumption increases as which of the following parameters increase? 1. Preload, afterload, and cerebral blood flow 2. Preload, afterload, and contractility 3. Preload, afterload, contractility, and heart rate 12

4. Preload, afterload, cerebral blood flow, and heart rate 75. 3. Myocardial oxygen consumption increases as preload, aftefioad, contractility, and heart rate increase. Cerebral blood flow doesn't directly affect myocardial oxygen consumption. 76. Which of the following factors would be most useful in detecting a client's risk of developing cardiogenic sliock? 1. Decreased heart rate 2. Decreased cardiac index 3. Decreased blood pressure 4. Decreased cerebral blood flow 76. 2. The cardiac index, a figure derived by dividing the cardiac output by the client's body surface area, is used for identifying whether the cardiac output is meeting a client's needs. Decreased cerebral blood flow, blood pressure, and heart rate are less useful in detecting the risk of cardiogenic shock. 77. Which of the following symptoms is one of the earliest signs of cardiogenic shock? 1. Tachycardia 2. Decreased urine output 3. Presence of S4 heart sounds 4. Altered level of consciousness 77.4. Initially, the decrease in cardiac output results in a decrease in cerebral blood flow that causes restlessness, agitation, or confusion. Tachycardia, decreased urine output, and presence of an S4 heart sound are all later signs of shock. 78. Which of the following diagnostic studies can determine when cellular metabolism becomes anaerobic and when pH decreases? 1. Arterial blood gas (ABG) levels 2. Complete blood count (CBC) 3. Electrocardiogram (ECG) 4. Lung scan 78. 1. ABG levels reflect cellular metabolism and indicate hypoxia. A CBC is performed to determine various constituents of venous blood. An ECG shows the electrical activity of the heart. A lung scan is performed to view functionality of the lungs. 79. Which of the following is the initial treatment goal

for cardiogenic shock? 1. Correct hypoxia 2. Prevent infarction 3. Correct metabolic acidosis 4. Increase myocardial oxygen supply 79. 4. A balance must be maintained between oxygen supply and demand. In a shock state, the myocardium requires more oxygen. If it can't get more oxygen, the shock worsens. Increasing the oxygen will also play a large role in correcting metabolic acidosis and hypoxia. Infarction typically causes the shock state, so prevention isn't an appropriate goal for this condition. 80. Which of the following drugs is most commonly used to treat cardiogenic shock? 1. Dopamine (Intropin) 2. Enalapril (Vasotec) 3. Furosemide (Lasix) 4. Metoprolol (Lopressor) 80. 1. Dopamine, a sympathomimetic drug, improves myocardial contractility and blood flow through vital organs by increasing perfusion pressure. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a betaadrenergic blocker that slows both heart rate and blood pressure, neither a desired effect in the treatment of cardiogenic shock. 81. Which of the following instruments is used as a diagnostic and monitoring tool for determining the severity of a shock state? 1. Arterial line 2. Indwelling urinary catheter 3. Intra-aortic balloon pump (IABP) 4. Pulmonary artery catheter 81.4. A pulmonary artery catheter is used to give accurate pressure measurements within the heart, which aids in determining the course of treatment. An arterial line is used to directly assess blood pressure continuously. An indwelling urinary catheter is used to drain the bladder. An IABP is an assistive device used to rest the damaged heart. 82. Which of the following parameters represents the World Health Organization's definition of 13

hypertension? 1. Systolic blood pressure of 160 mm Hg or higher, or diastolic blood pressure of 95 mm Hg or higher 2. Systolic blood pressure of 160 mm Hg or higher, or diastolic blood pressure of 95 mm Hg or lower 3. Systolic blood pressure below 160 mm Hg, or diastolic blood pressure of 95 mm Hg or higher 4. Systolic blood pressure below 160 mm Hg, or diastolic blood pressure of 95 mm Hg or lower 82.1. These values are compared to a normal adult with a systolic blood pressure of 140 mm Hg or lower, and a diastolic blood pressure of 90 mm Hg or lower. The other values are outside the acceptable standards put forth by the World Health Organization. 83. Which of the following sounds will be heard during the first phase of Korotkoff's sounds? 1. Disappearance of sounds 2. Faint, clear tapping sounds 3. A murmur or swishing sounds 4. Soft, muffling sounds 83. 2. In phase I, auscultation produces a faint, clear tapping sound that gradually increases in intensity. Phase II produces a murmur sound, and precedes Phase III, the phase marked by an increased intensity of sound. Phase IV produces a muffling sound that gives a soft blowing noise. Phase V, the final phase, is marked by the disappearance of sounds. 84. Which of the following parameters is the major determinant of diastolic blood pressure? 1. Baroreceptors 2. Cardiac output 3. Renal function 4. Vascular resistance 84. 4. Vascular resistance is the impedance of blood flow by the arterioles that most predominantly affects the diastolic pressure. Baroreceptors are nerve endings that are embedded in the blood vessels and respond to the stretching of vessel walls. They don't directly affect diastolic blood pressure. Cardiac output determines systolic blood pressure. Renal function helps control blood volume and indirectly affects diastolic blood pressure. 85. Which of the following factors can cause blood presstire to drop to normal levels?

1. Kidneys' excretion of sodium only 2. Kidneys' retention of sodium and water 3. Kidneys' excretion of sodium and water 4. Kidneys' retention of sodium and excretion of water 85. 3. The kidneys respond to a rise in blood pressure by excreting sodium and excess water. This response ultimately affects systolic blood pressure by regulating blood volume. The retention of either sodium or water would only further increase blood pressure. Sodium and water travel together across the membrane in the kidneys; one can't travel without the other. 86. Chemoreceptors in the carotid artery walls, aorta, and medulla respond to which of the following conditions? 1. Decreased blood pressure 2. Increased blood pressure 3. Decreased pulse 4. Increased pulse 86. 3. Chemoreceptors respond to a decrease in blood pressure by stimulating sympathetic nervous system activity. The receptors don't respond to the other conditions. 87. Which of the following hormones is responsible for raising arterial pressure and promoting venous return? 1. Angiotensin I 2. Angiotensin II 3. Epinephrine 4. Renin 87. 2. Angiotensin II is triggered by angiotensin I and is responsible for vasoconstriction, thereby increasing arterial blood pressure. Angiotensin I is the hormone that causes angiotensin II to respond. Epinephrine is a direct sympathetic nervous system cardiovascular stimulant that increases the heart rate. Renin produces angiotensin I when triggered by reduced blood flow. 88. Which of the following terms is used to describe persistently elevated blood pressure with an unknown cause that accounts for approximately 90% of hypertension cases? 1. Accelerated hypertension 2. Malignant hypertension 14

3. Primary hypertension 4. Secondary hypertension 88. 3. Characterized by a progressive, usually asymptomatic blood pressure increase over several years, primary hypertension is the most common type. Malignant hypertension, also known as accelerated hypertension, is rapidly progressive, uncontrollable, and causes a rapid onset of complications. Secondary hypertension occurs secondary to a known, correctable cause. 89. Which of the following symptoms of hypertension is most common? 1. Blurred vision 2. Epistaxis 3. Headache 4. Peripheral edema 89.3. An occipital headache is typical of hypertension secondary to continued increased pressure on the cerebral vasculature. Epistaxis (nosebleed) occurs far less frequently than a headache but can also be a diagnostic sign of hypertension. Blurred vision can result from hypertension due to the arteriolar changes in the eye. Peripheral edema can also occur from an increase in sodium and water retention but is usually a latent sign. 90. The bell of the stethoscope is most commonly placed over which of the following arteries to obtain a blood pressure measurement? 1. Brachial 2. Brachiocephalic 3. Radial 4. Ulnar 90. 1. The brachial artery is most commonly used due to its easy accessibility and location. The brachiocephalic artery isn't accessible for blood pressure measurement. The radial and ulnar arteries can be used in extraordinary circumstances, but the measurement may not be as accurate. 91. Which of the following statements explains why furosemide hypertension? 1. It dilates peripheral blood vessels. 2. It decreases sympathetic cardioacceleration. 3. It inhibits the angiotensin-converting enzyme. (Lasix) is administered to treat

4. It inhibits reabsorption of sodium and water in the loop of Henle. 91.4. Furosemide is a loop diuretic that inhibits sodium and water reabsorption in the loop of Henle, thereby causing a decrease in blood pressure. Vasodilators cause dilation of peripheral blood vessels, directly relaxing vascular smooth muscle and decreasing blood pressure. Adrenergic blockers decrease sympathetic cardioacceleration and decrease blood pressure. Angiotensin-converting enzyme inhibitors decrease blood pressure due to their action on angiotensin. 92. The hypothalamus responds to a decrease in blood pressure by secreting which of the following substances? 1. Angiotensin 2. Antidiuretic hormone (ADH) 3. Epinephrine 4. Renin 92. 2. ADH acts on the renal tubules to promote water retention, which increases blood pressure. Angiotensin, epinephrine, and rennin aren't stored in the hypothalamus but they all help to increase blood pressure. 93. Which of the following parts of the eye is examined 1. Cornea 2. Fovea 3. Retina 4. Sclera 93. 3. The retina is the only site in the body where arteries can be seen without invasive techniques. Changes in the retinal arteries signal similar damage to vessels elsewhere. The cornea is the nonvascular, transparent fibrous coat where the iris can be seen. The fovea is the point of central vision. The sclera is the fibrous tissue that forms the outer protective covering over the eyeball. 94. Which of the following conditions causes varicose veins? 1. Tunica media tear 2. Intraluminal occlusion 3. Intraluminal valvular compression 15 to see arterial changes caused by hypertension?

4. Intraluminal valvular incompetence 94. 4. Varicose veins, dilated tortuous surface veins engorged with blood, result from intraluminal valvular incompetence. An intraluminal occlusion would result from plaque or thrombosis. The valves aren't outside the lumen (intraluminal) and a tear would result in a hematoma. 95. Which of the following factors causes primary varicose veins? 1. Hypertension 2. Pregnancy 3. Thrombosis 4. Trauma 95.2. Primary varicose veins have a gradual onset and progressively worsen. In pregnancy, the expanding uterus and increased vascular volume impede blood return to the heart. The pressure places increased stress on the veins. Hypertension has no role in varicose vein formation. Thrombosis and trauma cause valvular incompetence and so are secondary causes of varicosities not primary. 96. Which of the following symptoms commonly occur in a client with varicose veins? 1. Fatigue and pressure 2. Fatigue and cool feet 3. Sharp pain and fatigue 4. Sharp pain and cool feet 96. 1. Fatigue and pressure are classic signs of varicose veins, secondary to increased blood volume and edema. Sharp pain and cool feet are symptoms of alteration in arterial blood flow. 97. In which of the following veins do varicose veins most commonly occur? 1. Brachial 2. Femoral 3. Renal 4. Saphenous 97. 4. Varicose veins occur most frequently in the saphenous veins of the lower extremities. They don't develop in the brachial, femoral or renal veins. 98. Which of the following conditions is caused by increased hydrostatic pressure and chronic venous stasis? 1. Venous occlusion

2. Cool extremities 3. Nocturnal calf muscle cramps 4. Diminished blood supply to the feet 98. 3. Calf muscle cramps result from increased pressure and venous stasis secondary to varicose veins. An occlusion is a blockage of blood flow. Cool extremities and diminished blood supply to the feet are symptoms of arterial blood flow changes. 99. Which of the following activities should a client with varicose veins avoid? 1. Exercise 2. Leg elevations 3. Prolonged lying 4. Wearing tight clothing 99. 4. Tight clothing, especially below the waist, increases vascular volume and impedes blood return to the heart. Exercise, leg elevations, and lying down usually relieve symptoms of varicose veins. 100. Which of the following tests demonstrates the backward flow of blood through incompetent valves of superficial veins? 1. Trendelenburg's test 2. Manual compression test 3. Perthes' test 4. Plethysmography 100. 1. Trendelenburg's test is the most accurate tool used to determine retrograde venous filling. The manual compression test is a quick, easy test done by palpation and usually isn't diagnostic of the backward flow of blood. Perthes' test easily indicates whether the deeper venous system and communicating veins are competent. Plethysmography allows measurement of changes in venous blood volume. 101. Which of the following signs and symptoms are produced by secondary varicose veins? 1. Pallor and severe pain 2. Severe pain and edema 3. Edema and pigmentation 4. Absent hair growth and pigmentation 101. 3. Secondary varicose veins result from an obstruction of the deep veins. Incompetent valves lead to impaired blood flow, and edema and pigmentation result from venous stasis. Severe pain, pallor, and absent hair growth are symptoms of an altered arterial 16

blood flow. 102. Which of the following treatments can be used to eliminate varicose veins? 1. Ablation therapy 2. Cold therapy 3. Ligation and stripping 4. Radiation 102. 3. Ligation and stripping of the vein can rid the vein of varicosity. This invasive procedure will take care of current varicose veins only; it won't prevent others from forming. The other procedures aren't used for varicose veins. 103. Which of the following treatments is recommended for postoperative management of a client who has undergone ligation and stripping? 1. Sitting 2. Bed rest 3. Ice packs 4. Elastic leg compression 103. 4. Elastic leg compression helps venous return to the heart, thereby decreasing venous stasis. Sitting and bed rest are contraindicated because both promote decreased blood return to the heart and venous stasis. Although ice packs would help reduce edema, they would also cause vasoconstriction and impede blood flow. 104. Which of the following factors usually causes deep vein thrombosis (DVT)? 1. Aerobic exercise 2. Inactivity 3. Pregnancy 4. Tight clothing 104. 2. A thrombus lodged in a vein can cause venous occlusion as a result of venous stasis. Inactivity can cause venous stasis, leading to DVT. Aerobic exercise helps to prevent venous stasis. Pregnancy and tight clothing can cause varicose veins, which can lead to venous stasis and eventually DVT, but these aren't primary causes. 105. Which of the following terms is used to describe a thrombus lodged in the lungs? 1. Hemothorax 2. Pneumothorax 3. Pulmonary embolism

4. Pulmonary hypertension 105. 3. A pulmonary embolism is a blood clot lodged in the pulmonary vasculature. A hemothorax refers to blood in the pleural space. A pneumothorax is caused by an opening in the pleura. Pulmonary hypertension is an increase in pulmonary artery pressure, which increases the workload of the right ventricle. 106. Which of the following terms refers to the condition of blood coagulating faster than normal, causing thrombin and other clotting factors to multiply? 1. Embolus 2. Hypercoagnlability 3. Venous stasis 4. Venous wall injury 106. 2. Hypercoagulability is the condition of blood coagulating faster than normal, causing thrombin and other clotting factors to multiply. This condition, along with venous stasis and venous wall injury, accounts for the formation of deep vein thrombosis. An embolns is a blood clot or fatty globule that formed in one area and is carried through the bloodstream to another area. 107. Which of the following characteristics is typical of the pain associated with deep vein thrombosis (DVT) ? 1. Dull ache 2. No pain 3. Sudden onset 4. Tingling 107. 3. DVT is associated with deep leg pain of sudden onset, which occurs secondary to the occlusion. A dull ache is more commonly associated with varicose veins. A tingling sensation is associated with an alteration in arterial blood flow. If the thrombus is large enough, it will cause pain. 108. Which of the following treatments can relieve pain from deep vein thrombosis (DVT)? 1. Application of heat 2. Bed rest 3. Exercise 4. Leg elevation 108. 4. Leg elevation alleviates the pressure caused by 17

thrombosis and occlusion by assisting venous return. The application of heat would dilate the vessels and pool blood in the area of the thrombus, increasing the risk of further thrombus formation. Bed rest adds to venous stasis by increasing the risk of thrombosis formation. When DVT is diagnosed, exercise isn't recommended until the clot has dissolved. 109. Which of the following terms best describes the findings on cautious palpation of the vein in typical superficial thrombophlebitis? 1. Dilated 2. Knotty 3. Smooth 4. Tortuous 109. 2. The knotty feeling is secondary to the emboli adhering to the vein wall. Varicose veins may be described as dilated and tortuous. Normal veins feel smooth. 110. Which of the following terms is used to describe pain in the calf due to sharp dorsiflexion of the foot? 1. Dyskinesia 2. Eversion 3. Positive Babinski's reflex 4. Positive Homans' sign 110. 4. A positive Homans' sign (elicited by quickly dorsiflexing the foot), when accompanied by other findings, is diagnostic of deep vein thrombosis (DVT). Alone, however, Homans' sign can't be used to diagnose DVT because other conditions of the calf can produce a positive Homans' sign. Dyskinesia is the inability to perform voluntary movement. Eversion is the outward movement of the transverse tarsal joint. A positive Babinski's reflex is an extensor plantar response. 111. Which of the following conditions causes intermittent claudication (cramplike pains in the calves)? 1. Inadequate blood supply 2. Elevated leg position 3. Dependent leg position 4. Inadequate muscle oxygenation 111.4. When a muscle is starved of oxygen, it produces pain much like that of angina. Inadequate blood supply would cause necrosis. Leg position

either alleviates or aggravates the condition. 112. Which of the following medical treatments should be administered to treat intermittent claudication? 1. Analgesics 2. Warfarin (Coumadin) 3. Heparin 4. Pentoxifylline (Trental) 112. 4. Pentoxifylline decreases blood viscosity, increases red blood cell flexibility, and improves flow through small vessels. Analgesics are administered for pain relief. Warfarin and heparin are anticoagulants. 113. Which of the following oral medications is administered to prevent further thrombus formation? 1. Warfarin (Coumadin) 2. Heparin 3. Furosemide (Lasix) 4. Metoprolol (Lopressor) 113. 1. Warfarin prevents vitamin K from synthesizing certain clotting factors. This oral anticoagulant can be given long-term. Heparin is a parenteral anticoagulant that interferes with coagulation by readily combining with antithrombin; it can't be given by mouth. Neither furosemide nor metoprolol affect anticoagulation. 114. Which of the following positions would best aid breathing for a client with acute pulmonary edema? 1. Lying flat in bed 2. Left side-lying 3. In high Fowler's position 4. In semi-Fowler's position 114. 3. A high Fowler's position facilitates breathing by reducing venous return. Lying flat and side-lying positions worsen the breathing and increase workload of the heart. Semi-Fowler's position won't reduce the workload of the heart as well as Fowler's position will. 115. Which of the following blood gas abnormalities is initially most suggestive of pulmonary edema? 1. Anoxia 2. Hypercapnia 3. Hyperoxygenation 4. Hypocapnia 115. 4. In an attempt to compensate for increased 18

work of breathing due to hyperventilation, the CO2 decreases, causing hypocapnia. If the condition persists, CO2 retention occurs and hypercapnia results. Although oxygenation is relatively low, the client isn't anoxic. Hyperoxygenation would result if the client was given oxygen in excess. However, secondary to fluid build-up, the client would have a low oxygenation level. 116. Which of the following responses does the body initially experience when cardiac output falls? 1. Decreased blood pressure 2. Alteration in level of consciousness (LOC) 3. Decreased blood pressure and diuresis 4. Increased blood pressure and fluid volume 116. 4. The body compensates for a decrease in cardiac output with a rise in blood pressure, due to the stimulation of the sympathetic nervous system and an increase in blood volume as the kidneys retain sodium and water. Blood pressure doesn't initially drop in response to the compensatory mechanism of the body. Alteration in LOC will occur only if the decreased cardiac output persists. 117. Which of the following actions is the appropriate initial response to a client coughing up pink, frothy sputum? 1. Call for help. 2. Call the physician. 3. Start an I.V. line. 4. Suction the client. 117. 1. Production of pink, frothy sputum is a classic sign of acute pulmonary edema. Because the client is at high risk for decompensation, the nurse should call for help but not leave the room. The other three interventions would immediately follow. 118. Which of the following precautions should a client be instructed to take after an episode of acute pulmonary edema? 1. Limit caloric intake. 2. Restrict carbohydrates. 3. Measure weight twice each day. 4. Call the physician if there is weight gain of more than 3 lb in 1 day. 118. 4. Gaining 3 lb in 1 day is indicative of fluid retention that would increase the workload of the

heart, thereby putting the client at risk for acute pulmonary edema. Restricting carbohydrates wouldn't affect fluid status. The body needs carbohydrates for energy and healing. Limiting caloric intake doesn't influence fluid status. The client must be weighed in the morning after the first urination. If the client is weighed later in the day, the finding wouldn't be accurate because of fluid intake during the day. 119. Which of the following terms describes the force against which the ventricle must expel blood? 1. Afterload 2. Cardiac output 3. Overload 4. Preload 119. 1. Aftefioad refers to the resistance normally maintained by the aortic and pulmonic valves, the condition and tone of the aorta, and the resistance offered by the systemic and pulmonary arterioles. Cardiac output is the amount of blood expelled from the heart per minute. Overload refers to an abundance of circulating volume. Preload is the volume of blood in the ventricle at the end of diastole. 120. After recovery from an episode of acute pulmonary edema, why would an angiotensinconverting enzyme inhibitor be administered? 1. To promote diuresis 2. To increase contractility 3. To decrease contractility 4. To reduce blood pressure 120. 4. Angiotensin-converting enzyme inhibitors are given to reduce blood pressure by decreasing the workload of the heart. Diuretics are given to promote diuresis. Inotropic agents increase contractility. Negative inotropic agents decrease contractility. 121. Acute pulmonary edema caused by heart failure is usually a result of damage to which of the following areas of the heart? 1. Left atrium 2. Right atrium 3. Left ventricle 4. Right ventricle 121.3. The left ventricle is responsible for the majority of force for the cardiac output. If the left ventricle is damaged, the output decreases and fluid accumulates 19

in the interstitial and alveolar spaces, causing pulmonary edema. Damage to the left atrium would contribute to heart failure but wouldn't affect cardiac output, or, therefore, the onset of pulmonary edema, if the right atrium and right ventricle were damaged, right-sided heart failure would result. 122. How quickly can an episode of acute pulmonary edema develop? 1. In minutes 2. In 1/2 hour 3. In 1 hour 4. In 3 hours 122. 1. Pulmonary edema can develop in minutes, secondary to a sudden fluid shift from the pulmonary vasculature to the lung interstitial alveoli. 123. Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole? 1. Afterload 2. Cardiac index 3. Cardiac output 4. Preload 123. 4. In clients with pulmonary edema, preload increases and cardiac output drops. Afterload, the force against which the ventricle must expel blood, also increases in pulmonary edema. Cardiac index is the individualized measurement of cardiac output, based on the client's body surface area. Cardiac output is the amount of blood the heart is expelling per minute. 124. Which of the following actions should a nurse take when administering a new blood pressure medication to a client? 1. Administer the medication to the client without explanation. 2. Inform the client of the new drug only if he asks about it. 3. Inform the client of the new medication, its name, use, and the reason for the change. 4. Administer the medication and inform the client that the physician will later explain the medication. 124. 3. Informing the client of the medication, its use, and the reason for the change is important to the care of the client. Teaching the client about his treatment

regimen promotes compliance. The other responses are inappropriate. 125. Antihypertensives should be used cautiously in clients taking which of the following drugs? 1. Ibuprofen (Advil) 2. Diphenhydramine (Benadryl) 3. Thioridazine (Mellaril) 4. Vitamins 125. 3. Thioridazine affects the neurotransmitter norepinephrine, which causes hypotension and other cardiovascular effects. Administering an antihypertensive to a client who already has hypotension could have serious adverse effects. Ibuprofen is an anti-inflammatory that doesn't interfere with the cardiovascular system. Although diphenhydramine does have histaminic effects, such as sedation, it isn't known to decrease blood pressure. Vitamins aren't drugs and don't interfere with cardiovascular function.

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