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Question 1
When advising a morbidly obese client about the benefits of weight reduction, which statement would be most accurate to share?Selected Answer: C.
“A 10-pound loss of weight can produce a decrease in blood pressure.”Answers: A.
B.
C.
D.
Response Feedback: Rationale: Weight reduction of as little as 4.5 kg (10 lbs) can produce a decrease in BP in a large proportion of overweight people with hypertension. There is no data to suggest this client has a high intake of sodas. An increased waist-to-hip ratio is associated with hypertension. Leptin acts on the hypothalamus to increase BP by activating the SNS. -
Question 2
A nursing instructor is explaining the role of vascular smooth muscle cells in relation to increases in systemic circulation. During discussion, which neurotransmitter is primarily responsible for contraction of the entire muscle cell layer, thus resulting in decreased vessel lumen radius?Selected Answer: A.
NorepinephrineAnswers: A.
B.
C.
D.
Response Feedback: Rationale: Nerve cells and circulating hormones are responsible for vasoconstriction of the vessel walls. Because they do not enter the tunica media of the blood vessel, the nerves do not synapse directly on the smooth muscle cells. Instead, they release the neurotransmitter norepinephrine, which diffuses into the media and acts on the nearby smooth muscle cells; this results in contraction of the entire muscle cell layer and thus reduces the radius of the vessel lumen. This increases the systemic circulation. -
Question 3
During a routine physical exam for a client diagnosed with hypertension, the nurse practitioner will be most concerned if which assessment is found?Selected Answer: D.
Noted hemorrhages and microaneurysms during evaluation of internal eye.Answers: A.
B.
C.
D.
Response Feedback: Rationale: Hypertension affects the eye in sometimes devastating ways. If there are acute increases in BP, hemorrhages, microaneurysms, and hard exudates can manifest. Vibrations relate to hearing loss. The kidneys should not be palpable to touch. Varicose veins are not associated with hypertension. -
Question 4
In which of the following hospital clients would the care team most realistically anticipate finding normal cholesterol levels?Selected Answer: B.
A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weaknessAnswers: A.
B.
C.
D.
Response Feedback: Rationale: Hemorrhagic stroke is not a pathology noted to be associated with secondary hypercholesterolemia. Diabetes, thyroid medications, estrogen therapy, obesity, and beta-blocker medications are all correlated with hypercholesterolemia. -
Question 5
Following physical assessment, which abnormality(ies) leads the health care provider to suspect the client has metabolic syndrome? Select all that apply.Selected Answers: C.
Five foot (1.5 meter) tall female with abdominal waist measurement of 45 inches (114 cm)D.
Sitting blood pressure reading of 145/96 mm HgE.
Fasting triglyceride level of 230 mg/dL 92.6 mmol/L)Answers: A.
B.
C.
D.
E.
Response Feedback: Rationale: Metabolic syndrome is defined as the presence of three or more of the following: elevated fasting blood glucose; elevated blood pressure; elevated waist circumference; and dyslipidemia reflected by increased triglycerides and/or decreased HDL. In this client, the glucose level is normal and the HDL level is elevated, which is good. The blood pressure is elevated, the waist is too high and the triglycerides are elevated as well. -
Question 6
A young woman has been diagnosed by her family physician with primary Raynaud disease. The woman is distraught, stating, “I’ve always been healthy and I can’t believe I have a disease now.” What would be her physician’s most appropriate response?Selected Answer: C.
“If you make sure to keep yourself warm, it will have a fairly minimal effect; I’ll also give you pills to enhance your circulation.”Answers: A.
B.
C.
D.
Response Feedback: Rationale: Ensuring total body warmth and the use of vasodilators are the normal treatment modalities for Raynaud disease. -
Question 7
When a 55-year-old client’s routine blood work returns, the nurse notes that the client’s C-reactive protein (CRP) is elevated. The client asks what that means. The nurse responds:Selected Answer: B.
“This means you have elevated serum markers for systemic inflammation that has been associated with vascular disease.”Answers: A.
B.
C.
D.
Response Feedback: Rationale: CRP is a serum marker for systemic inflammation. Elevated levels are associated with vascular disease. The normal metabolism of homocysteine requires adequate levels of folate, vitamin B 6, vitamin B 12, and riboflavin. CRP is not associated with red meat consumption. LDL is an independent risk factor for development of premature coronary heart disease. -
Question 8
A number of older adults have come to attend a wellness clinic that includes both blood pressure monitoring and education about how to best control blood pressure. Which teaching point is most accurate?Selected Answer: D.
“Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure.”Answers: A.
B.
C.
D.
Response Feedback: Rationale: Obesity, excess alcohol consumption, and a sedentary lifestyle are all linked with hypertension. Inadequate, rather than excessive, potassium intake is thought to be causative and while race and family influence an individual’s predisposition to hypertension, it does not render the condition untreatable or uncontrollable. Diabetes is thought to be a contributor to hypertension, not vice versa. -
Question 9
A 70-year-old male client presents to the emergency department reporting pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. The nurse knows that the client is likely experiencing which medical diagnosis/possible treatment plan listed below?Selected Answer: C.
Atherosclerotic occlusive disease necessitating thrombolytic therapyAnswers: A.
B.
C.
D.
Response Feedback: Rationale: The client’s symptoms of calf pain with intermittent claudication and diminished pulses are the hallmarks of atherosclerotic occlusive disease. These signs and symptoms are not as closely associated with acute arterial occlusion or giant cell temporal arteritis and are not related to Raynaud disease. -
Question 10
A 78-year-old male client has undergone a total knee replacement. He just doesn’t feel like getting out of bed and moving around. After 3 days of staying in bed, the physical therapist encourages him to get out of bed to the chair for meals. He starts to complain of dizziness and lightheadedness. These symptoms are primarily caused by which pathophysiologic principle? Select all that apply.Selected Answers: B.
Client is experiencing a reduction in plasma volume.D.
Peripheral vasoconstriction mechanism has failed.Answers: A.
B.
C.
D.
E.
Response Feedback: Rationale: Prolonged bed rest promotes a reduction in plasma volume, a decrease in venous tone, failure of peripheral vasoconstriction, and weakness of the skeletal muscles that support the veins and assist in returning blood to the heart. Endorphins make one feel better in mood. After three days post-op, there should be no further bleeding from the surgical site. If there is, then this is a complication that must be addressed immediately. Loss of vascular and skeletal muscle tone is less predictable but probably becomes maximal after 2 weeks. -
Question 11
A physician is providing care for several clients on a medical unit of a hospital. In which situation would the physician be most likely to rule out hypertension as a contributing factor?Selected Answer: D.
A 61-year-old man who has a heart valve infection and recurrent feverAnswers: A.
B.
C.
D.
Response Feedback: Rationale: While cardiac complications are common sequelae of hypertension, a heart infection is less likely. Stroke, kidney failure, and angina are all identified as consequences of hypertension. -
Question 12
The nurse practitioner is working in an overnight sleep lab assessing and diagnosing clients with sleep apnea. During this diagnostic procedure, the nurse notes that a client’s blood pressure is 162/97 mm Hg. The nurse explains this connection to the client based on which pathophysiologic principle?Selected Answer: C.
During apneic periods the client experiences hypoxemia, which stimulates chemoreceptors to induce vasoconstriction.Answers: A.
B.
C.
D.
Response Feedback: Rationale: People with sleep apnea also may experience an increase in BP because of the hypoxemia that occurs during the apneic periods. The specialized chemoreceptors are located in carotid bodies and aortic bodies of the aorta. Retention of fluid is not the cause of increased BP during sleep apnea episodes. -
Question 13
An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which components of the pathologist’s report is most suggestive of a possible history of poorly controlled blood pressure?Selected Answer: B.
“Arterial sclerosis of subcortical brain regions noted.”Answers: A.
B.
C.
D.
Response Feedback: Rationale: Neurological consequences of hypertension include narrowing and sclerosis of subcortical regions. Urethral scarring and impaired venous return would be less likely to derive from hypertension, and while nephrosclerosis and glomerular damage are associated with hypertension, hypertrophy of the kidneys themselves is not noted as an indicator. -
Question 14
Which client on the nurse’s team will be given priority for cardiac monitoring based on medical history?Selected Answer: C.
Adolescent client resuscitated following drowning in a swimming pool that required CPR at the sceneAnswers: A.
B.
C.
D.
Response Feedback: Rationale: Examples of clients categorized as class I are those who have been resuscitated from a cardiac arrest, are in the early phase of acute coronary syndrome, have unstable coronary syndromes or newly diagnosed high-risk coronary lesions, or have had recent cardiac surgery. Given these guidelines, the adolescent client who was resuscitated by CPR at the pool is the priority of this group of clients. A client with diabetes is at risk for coronary disease but this client underwent surgery without mention of cardiac abnormalities, which places the client at a lower priority for a monitor. The client with COPD is not the priority for monitoring, even though the client has a pacemaker. An older adult client needing IV antibiotics is also a lower priority for continuous monitoring of cardiac rhythm. -
Question 15
A physician has ordered the measurement of a cardiac client’s electrolyte levels as part of the client’s morning blood work. Which statement best captures the importance of potassium in the normal electrical function of the client’s heart?Selected Answer: B.
Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.Answers: A.
B.
C.
D.
Response Feedback: Rationale: The selective permeability of cell membranes to potassium, and its near-impermeability to sodium ions, produces the resting membrane potential of cardiac cells. Potassium does not catalyze the metabolism of ATP, and sodium and potassium ions do not move across the cell membrane in a 1:1 ratio. -
Question 16
A client is believed to be in cardiac arrest and defibrillation is being performed. What is an aspect of the rationale and physiology of defibrillation treatment?Selected Answer: A.
The goal is to depolarize the entire heart during the passage of current.Answers: A.
B.
C.
D.
Response Feedback: Rationale: The benefits of defibrillation are achieved by depolarizing the heart during the passage of current, allowing the SA node to regain control. It is not achieved by the use of a pacemaker. Cardioversion, not defibrillation, is coincided with the R wave. The SA node, not the AV node, is the source of cardiac conduction and the natural pacemaker. -
Question 17
The nurse has completed an automated blood pressure and pulse reading on a client with persistent atrial fibrillation. The client’s baseline values are blood pressure 130/85 mm Hg and heart rate of 80 bpm and irregular. The current result is blood pressure is 98/47 mm Hg, the heart rate is 77 bpm, and the client denies feeling differently. What is the nurse’s priority action?Selected Answer: B.
Perform a manual blood pressure and apical heart rate reading.Answers: A.
B.
C.
D.
Response Feedback: Rationale: The ventricular response in atrial fibrillation is completely irregular. Because of changes in stroke volumes resulting from varying periods of diastolic filling, not all ventricular beats produce a palpable pulse. Using an automated machine means some of the pulses required to assess blood pressure may be inaudible and result in an inaccurate reading. The nurse should verify the results using a manual reading of both blood pressure and apical heart rate. The nurse would also use the client’s current symptoms as a guide to decision making but should not change the position, or notify the health care provider until the reading is verified. Analyzing a past electrocardiogram would also be unnecessary until the reading is confirmed. -
Question 18
Which statement describes phase 4 of the action potential of cells in the sinoatrial (SA) node?Selected Answer: C.
A slow depolarization occurs when Na + is transported out of the cell and K + moves back in, resulting in resting membrane potential.Answers: A.
B.
C.
D.
Response Feedback: Rationale: During phase 4 in the cells of the SA node, a slow leakage of current through the slow channels of the cellular membrane leads to spontaneous depolarization; this slow response enables pacemaker function. The cells responding to greater-than-normal stimulus describes the relative refractory period of the action potential curve, which occurs at the end of phase 3 in cardiac cells. The fast sodium channels in the cellular membranes closing describes phase 1 of the action potential, which signals the end of depolarization. The sodium-potassium pump transports sodium out of the cell, and a smaller amount of potassium into it, contributing to the negative intracellular charge of the resting membrane potential in phase 4. -
Question 19
A client with a new automatic implantable cardioverter-defibrillator (AICD) asks the nurse what happens if he goes into that deadly heart rhythm again. The nurse will base her response knowing the AICD will:Selected Answer: A.
respond to ventricular tachydysrhythmia by delivering a shock within 10-20 seconds of its onset.Answers: A.
B.
C.
D.
Response Feedback: Rationale: AICD successfully treats individuals with life-threatening ventricular tachydysrhythmias by use of intrathoracic electrical countershock. It senses and detects ventricular dysrhythmias. It responds by delivering an electrical shock between intrathoracic electrodes within 10 to 20 seconds of its onset. It does not periodically fire to test lead placement. It does not utilize radiofrequency energy (this is used in ablations). The procedure does not remove scar tissue or aneurysms. This is a ventriculotomy. -
Question 20
An ECG technician is placing leads on a client who has presented to the emergency department with a sudden onset of chest pain. The technician would recognize which fact about the placement of leads and the achievement of a clinically accurate ECG?Selected Answer: B.
The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane.Answers: A.
B.
C.
D.
Response Feedback: Rationale: A complete ECG is obtained by combining data from chest leads, which measure activity on the horizontal plane, and limb leads, corresponding to the vertical or frontal plane. The electrical potential recorded by a lead on an extremity should not vary significantly depending on where the lead is placed on the extremity. Limb leads do not measure electrical activity by way of skeletal muscle activity. A total of 12 leads, only six of which are on the chest, is necessary for a complete ECG. -
Question 21
A number of clients on an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which client is most deserving of immediate medical attention?Selected Answer: C.
A 69-year-old woman who has entered ventricular fibrillationAnswers: A.
B.
C.
D.
Response Feedback: Rationale: Ventricular fibrillation, or ventricular flutter, is a life-threatening emergency that would necessitate immediate intervention. Ventricular tachycardia is also a serious condition, but less so than ventricular fibrillation. PVCs and a first-degree AV block would not normally require emergency intervention. -
Question 22
A nurse is caring for four clients with the diagnosis of atrial fibrillation. Which client will likely require cardioversion related to complications?Selected Answer: C.
Newly diagnosed client with atrial fibrillation and has developed pulmonary edemaAnswers: A.
B.
C.
D.
Response Feedback: Rationale: Cardioversion may be considered in clients with atrial fibrillation, particularly when pulmonary edema and unstable cardiac status is present. The other clients have a complication related to lack of diagnosis or adverse reactions to prescribed treatments. -
Question 23
A client arrives reporting feeling “faint and dizzy” when standing and on telemetry the client’s heart rate is 25 beats/min. On electrocardiogram, the rate is fairly consistent and lacks the normal “P” wave and the QRS is wider than normal. This client’s heart rhythm is being controlled by which cardiac structure?Selected Answer: A.
Purkinje systemAnswers: A.
B.
C.
D.
Response Feedback: Rationale: When the SA node is not conducting impulses, the AV node can assume the pacemaker function at a rate of 40 to 60 times/min. Should the SA node and AV node fail to conduct impulses from the atria to the ventricles, the Purkinje system can assume the pacemaker function of the ventricles at a rate of 15 to 40 times/min. The bundle of His is an important part of the electrical conduction system of the heart, because it transmits impulses from the atrioventricular node, located at the inferior end of the interatrial septum, to the ventricles of the heart. -
Question 24
Assuming that they have not responded to drug therapy, which client is likely to be the best candidate for surgical cardiac ablation?Selected Answer: C.
A 46-year-old man with unstable angina and a history of myocardial infarction who is found to have long Q-T syndrome and episodes of frequent ventricular dysrhythmiasAnswers: A.
B.
C.
D.
Response Feedback: Rationale: Due to his history of MI, the 46-year-old man probably has several areas of necrotic tissue that are interfering with conduction and ventricular function, and would probably benefit from having them removed. The 62-year-old woman may have little or no myocardial tissue damage, so a less invasive procedure to improve her cardiac circulation would be a better choice for her. The 75-year-old man may not have any areas of infarction and is a risky surgical candidate because of his age and diabetes. The 22-year-old woman’s tachycardia is likely to be non-ischemic in origin. -
Question 25
During a sleep study in the laboratory, the health care provider notices one client has a prolonged period of asystole. Which term will the nurse use to describe this event in the documentation?Selected Answer: B.
Sinus arrestAnswers: A.
B.
C.
D.
Response Feedback: Rationale: Sinus arrest or pause refers to failure of the sinoatrial (SA) node to discharge and results in an irregular pulse. Sinus arrest may result in prolonged periods of asystole and can be caused by sleep apnea. Bradycardia-tachycardia syndrome is where the disease is caused in the sinus node and the tachycardia is caused by paroxysmal atrial or junctional arrhythmia. Most of the time, these clients do not know they have this arrhythmia because it is asymptomatic. Junctional rhythms usually have a rate of 40 to 60 beats/minute and can serve as a pacemaker of the heart in the event the SA node fails to initiate an impulse. The long QT syndrome is characterized by a prolongation of the QT interval that may result in a characteristic type of polymorphic ventricular tachycardia. -
Question 26
The nurse is prioritizing clients based on the risk for falls. Which client would be at greatest risk for sudden falls and related injury? The client:Selected Answer: D.
with uncontrolled sick sinus syndrome.Answers: A.
B.
C.
D.
Response Feedback: Rationale: The client with sick sinus syndrome is at risk for syncope related to sudden onset bradyarrhythmias that will decrease cardiac output and result in decreased perfusion of the brain. This loss of consciousness is unpredictable and would place the client at risk for injury. The person with type 1 diabetes may develop hyperglycemia but is not at risk for falls. A client who is immobile is less likely to fall because he or she is dependent on others for mobility (i.e., unable to get up unsupervised). Atrial fibrillation is generally asymptomatic unless a rapid ventricular response is present. The likelihood of a negative effect from the atrial fibrillation or use of anticoagulants resulting in a fall is far less likely than it is for the client with sick sinus syndrome. -
Question 27
A pathologist is examining histological (tissue) samples from a client with an autoimmune disease. Which characteristic of muscle samples would signal the pathologist that the samples are cardiac rather than skeletal muscle?Selected Answer: D.
The muscle cells are arranged as an interconnecting lattice-work.Answers: A.
B.
C.
D.
Response Feedback: Rationale: Cardiac muscle cells are arranged as an interconnecting lattice-work. Cardiac cells have a more defined sarcoplasmic reticulum than do skeletal muscles. They also have intercalated disks and large, numerous mitochondria. Both types of muscle are striated and composed of sarcomeres. -
Question 28
When explaining to a client why there was only minimal muscle damage following 99% occlusion of the left anterior descending artery, the nurse will explain that this is primarily due to:Selected Answer: B.
development of collateral circulation that build channels between some of the smaller arteries, usually when the flow is decreased gradually.Answers: A.
B.
C.
D.
Response Feedback: Rationale: Collateral circulation is a mechanism for the long-term regulation of local blood flow. Anastomotic channels exist between some of the smaller arteries. These channels permit perfusion of an area by more than one artery. When the artery becomes occluded, these anastomotic channels increase in size, allowing blood from a patent artery to perfuse the area supplied by the occluded vessel. -
Question 29
A client in the emergency department is experiencing a massive stroke with extremely low blood flow to the brain exhibited by a BP <60 mm Hg. The nurse suddenly notes there is a sharp rise in the BP to 250 mm Hg. This high BP lasts about 5 minutes and then the BP drops sharply again. The pathophysiologic principle behind this is likely due to the:Selected Answer: D.
CNS ischemic response.Answers: A.
B.
C.
D.
Response Feedback: Rationale: When blood flow to the brain has been sufficiently interrupted to cause ischemia of the vasomotor center, these vasomotor neurons become strongly excited. This causes massive vasoconstriction as a means of raising the blood pressure to levels as high as the heart can pump against. This response is called the CNS ischemic response and can raise BP to levels as high as 270 mm Hg for as long as 10 minutes. -
Question 30
The nurse is caring for a client with small veins. The nurse can improve the chance of successfully drawing a blood sample by applying the principle of critical closing pressure and:Selected Answer: B.
using minimal negative pressure when drawing the sample into the syringe.Answers: A.
B.
C.
D.
Response Feedback: Rationale: The critical closing pressure refers to the point at which blood vessels collapse so that blood can no longer flow through them. The nurse should not withdraw the blood quickly as this can cause the vein to contain too little blood to keep the walls patent. Raising the limb would cause less blood to be present due to the effects of gravity. Flushing the vein prior to drawing the sample would dilute the sample and make the results inaccurate. -
Question 31
In which situation would blood most likely be rapidly relocated from central circulation to the lower extremities?Selected Answer: B.
A client is helped out of bed and stands up.Answers: A.
B.
C.
D.
Response Feedback: Rationale: During a change in body position, blood is rapidly relocated from the central circulation (when the client is recumbent) to the lower extremities (when the client stands up). This results in a temporary drop in blood pressure known as postural hypotension and reflects the redistribution of blood in the body. -
Question 32
While intubated for surgery, a client has inadvertently had his vagus nerve stimulated. What effect would the surgical team expect to observe?Selected Answer: D.
Decreased heart rate as a result of parasympathetic innervation of the heartAnswers: A.
B.
C.
D.
Response Feedback: Rationale: Vagal stimulation results in a lowered heart rate as a result of parasympathetic stimulation. Vascular perfusion, contractility, and afterload would not be under direct effect. Acetylcholine reuptake would not be influenced. -
Question 33
During an automobile accident where the client is bleeding heavily, which vascular component is the most distensible and can store large quantities of blood that can be returned to the circulation at this time of need?Selected Answer: C.
VeinsAnswers: A.
B.
C.
D.
Response Feedback: Rationale: Compliance refers to the total quantity of blood that can be stored in a given portion of the circulation for each mm Hg rise in pressure. The most distensible of all vessels are the veins, which can increase their volume with only slight changes in pressure. This allows the veins to function as a reservoir for storing large quantities of blood that can be returned to the circulation when it is needed. Liver, pancreas, and kidneys are not vascular components. -
Question 34
A client is experiencing impaired circulation secondary to increased systemic arterial pressure. Which statement is the most relevant phenomenon?Selected Answer: C.
High afterload because of backpressure against the left ventricleAnswers: A.
B.
C.
D.
Response Feedback: Rationale: Increased pressure in the aorta and other arteries constitutes a greater amount of afterload work. This situation is not indicative of increased preload or impaired contractility. Systolic impairment is not a recognized characterization of inadequate cardiac performance. -
Question 35
A 72-year-old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the client that she has aortic stenosis. After the cardiologist has left the room, the client asks, “What caused this [aortic stenosis] to happen now?” The clinic nurse responds:Selected Answer: B.
“Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur.”Answers: A.
B.
C.
D.
Response Feedback: Rationale: Heart murmur results from turbulent flow through a diseased heart valve that may be narrow, too stiff, or too floppy. This turbulent flow causes a vibration called a murmur. -
Question 36
Analysis has shown that a client’s right atrial pressure is 30 mm Hg. What is the most likely conclusion that the client’s care team will draw from this piece of data?Selected Answer: B.
The pressure is excessive given that the right atrium should be at atmospheric pressure.Answers: A.
B.
C.
D.
Response Feedback: Rationale: Normal right atrial pressure is around 0 mm Hg, or atmospheric pressure. Right atrial pressure does not have a direct influence on stroke volume or pulse pressure. -
Question 37
An 81-year-old female client of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client’s condition?Selected Answer: A.
Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.Answers: A.
B.
C.
D.
Response Feedback: Rationale: Because there are no valves at the entry points to the atria, congestion can result in engorgement of the jugular veins which are proximal to the heart. Increased cardiac demand is not associated with engorgement of vessels or peripheral dilation. -
Question 38
When trying to explain to a client on dialysis the movement of substances through the capillary pores, the nurse will explain that in the kidneys, the glomerular capillaries have:Selected Answer: B.
Small openings that allow large amounts of smaller molecular substances to filter through the glomeruli.Answers: A.
B.
C.
D.
Response Feedback: Rationale: The glomerular capillaries in the kidneys have small openings called fenestrations that pass directly through the middle of the endothelial cells. This allows large amounts of small molecular and ionic substances to filter through the glomeruli without having to pass through the clefts between the endothelial cells. -
Question 39
Emergency medical technicians respond to a call to find an 80-year-old man who is showing signs and symptoms of severe shock. Which phenomenon is most likely taking place?Selected Answer: C.
The man’s alpha- and beta-adrenergic receptors have been activated, resulting in vasoconstriction and increased heart rate.Answers: A.
B.
C.
D.
Response Feedback: Rationale: Alpha- and beta-adrenergic receptor activation is a central response to all types of shock. Hemolysis is not a noted accompaniment to shock. Bronchodilation, not bronchoconstriction, often results from adrenergic stimulation. Sodium-potassium pump failure results in increased extracellular potassium and intracellular sodium. -
Question 40
A nurse is administering morning medications to a number of clients on a medical unit. Which medication regimen is most suggestive that the client has a diagnosis of heart failure?Selected Answer: B.
Diuretic, ACE inhibitor, beta-blockerAnswers: A.
B.
C.
D.
Response Feedback: Rationale: Diuretics, ACE inhibitors, and beta-blockers are all commonly used in the treatment of heart failure. Antiplatelet aggregators, calcium and potassium supplements, and anticoagulants are less likely to relate directly to a diagnosis of heart failure. -
Question 41
A 77-year-old client with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of “impending doom.” Based on pathophysiologic principles, the nurse knows the rapid heart rate could:Selected Answer: A.
be a result of catecholamines released from SNS, which could increase the myocardial oxygen demand.Answers: A.
B.
C.
D.
Response Feedback: Rationale: An increase in sympathetic activity by stimulation of the beta-adrenergic receptors of the heart leads to tachycardia, vasoconstriction, and dysrhythmias. Acutely, tachycardia significantly increases the workload of the heart, thus increasing myocardial O 2 demand and leading to cardiac ischemia, myocyte damage, and decreased contractility. Decrease renal perfusion would activate the RAAS system, increasing heart rate and BP further. Ventricular dysrhythmias are primarily seen at this stage of HF. -
Question 42
In which client situations would a physician be most justified in preliminarily ruling out pericarditis as a contributing pathology to the client’s health problems?Selected Answer: A.
A 77-year-old with diminished S 3 and S 4 heart tones, irregular heart rate, and a history of atrial fibrillationAnswers: A.
B.
C.
D.
Response Feedback: Rationale: S 3 and S 4 irregularities and irregular heart rate are not noted symptoms of pericarditis. Widespread T-wave inversions that later normalize; chest pain radiating to the neck and scapula that is worse on inspiration; and high white cells, erythrocyte sedimentation rate, and C-reactive protein levels are all indicators of pericarditis. -
Question 43
A nurse who works on a pediatric cardiology unit of a hospital is providing care for an infant with a diagnosis of tetralogy of Fallot. Which pathophysiologic result should the nurse anticipate?Selected Answer: B.
Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.Answers: A.
B.
C.
D.
Response Feedback: Rationale: Tetralogy of Fallot is marked by obstruction or narrowing of the pulmonary outflow channel, including pulmonic valve stenosis, a decrease in the size of the pulmonary trunk, or both. The characteristic septal defect is ventricular, not atrial. Aortic valve stenosis and right ventricular atrophy are not associated with the diagnosis. -
Question 44
A 3-year-old child with right-sided heart failure has been admitted for worsening of their condition. Which assessment would be considered one of the earliest signs of systemic venous congestion in this toddler?Selected Answer: A.
Enlargement of liverAnswers: A.
B.
C.
D.
Response Feedback: Rationale: With RV function impaired, systemic venous congestion develops. Hepatomegaly due to liver congestion often is one of the first signs of systemic venous congestion in infants and children. -
Question 45
Four clients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which client most likely experienced myocardial infarction?Selected Answer: A.
An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently roseAnswers: A.
B.
C.
D.
Response Feedback: Rationale: The chest pain of myocardial infarction does not respond to rest or to nitrates. Ischemic injury to the myocardium alters the ECG patterns, often elevating the ST segment and inverting T waves. Abnormal Q waves indicate necrosis. Cardiac markers are released in response to myocardial injury; rising levels indicate damage to the heart. The other clients have angina of varying severity. -
Question 46
A number of clients have presented to the emergency department in the last 32 hours with reports that are preliminarily indicative of myocardial infarction. Which client is least likely to have an ST-segment myocardial infarction (STEMI)?Selected Answer: A.
A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at restAnswers: A.
B.
C.
D.
Response Feedback: Rationale: STEMI pain is not normally relieved by rest, nor would fever be a common symptom. Shortness of breath, vague chest discomfort, fatigue, GI symptoms and radiating substernal pain are all associated with STEMI. -
Question 47
Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate 112, respiratory rate 36, and pulse oximeter reading of 81%. He starts coughing up frothy, pink sputum. The priority intervention is:Selected Answer: B.
Call for emergency assistance utilizing hospital protocol.Answers: A.
B.
C.
D.
Response Feedback: Rationale: Mr. V. is experiencing acute pulmonary edema. This is a life-threatening condition. The person is seen sitting and gasping for air. The pulse is rapid, skin moist, lips/nail beds cyanotic. Dyspnea and air hunger are accompanied by productive cough with frothy and often blood-tinged sputum (pink). The client needs the emergency responder team (including ICU nurses, physicians, respiratory therapy, etc) to intervene. Applying O 2 by mask will not increase his oxygen level fast enough and he is probably mouth breathing (gasping for air). Suction equipment may be needed, but getting a physician to give orders for diuretics and inotropic medications is the priority. Of course, respiratory therapy will arrive with the emergency assistance team. -
Question 48
The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the client displaying which clinical manifestation?Selected Answer: B.
Dyspnea and crackles in bilateral lung bases.Answers: A.
B.
C.
D.
Response Feedback: Rationale: Although it may preserve the resting cardiac output, the resulting chronic elevation of left ventricular end-diastolic pressure is transmitted to the atria and the pulmonary circulation, causing pulmonary congestion. -
Question 49
Which teaching point would be most appropriate for a group of older adults who are concerned about their cardiac health?Selected Answer: A.
“The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel.”Answers: A.
B.
C.
D.
Response Feedback: Rationale: Stable plaque is associated with obstruction of blood flow, while unstable plaque may dislodge and result in thrombus formation. Plaque disruption is noted to correlate with sympathetic events and is not seemingly random; infections and respiratory problems are not noted to be associated, however. -
Question 50
A 30-year-old woman presents at a hospital after fainting at a memorial service and she is diagnosed as being in neurogenic shock. Which signs/symptoms is she most likely to display?Selected Answer: C.
Dry and warm skinAnswers: A.
B.
C.
D.
Response Feedback: Rationale: In contrast to hypovolemic shock, in which the heart rate is faster than normal and the skin is cold and clammy, a person in neurogenic shock is likely to have a slower than normal heart rate and dry, warm skin. Fainting due to emotional causes is a transient form of neurogenic shock, while increased thirst is an early sign of hypovolemic shock.