In which of the following patient situations would a physician be most justified in preliminarily
ruling out pericarditis as a contributing pathology to the patient's health problems? - ANSA
77-year-old with diminished S3 and S4 heart tones, irregular heart rate and history of a-fib
Following cardiac surgery, the nurse suspects the patient may be developing a cardiac
tamponade. Which of the following clinical manifestations would support this diagnosis? -
ANSMuffled heart tones, narrowed pulse pressure and low BP 84/60
Cardiac tamponade results in increased intracardiac pressure, progressive limitation of
ventricular diastolic filling and decrease SV and CO
Which of the following phenomena would be most likely to accompany increased myocardial
oxygen demand? - ANSIncreased aortic pressure
Results in rise in afterload, wall tension, ultimately MVO2
Which of the following teaching points would be most appropriate for a group of older adults
who are concerned about their cardiac health? - ANSThe 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
Stable plaque is associated with obstruction of blood flow, while unstable plaque may dislodge
and result in thrombus formation
Four patients 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 patient most likely experienced myocardial infarction? - ANSAn 80-year-old woman
whose pain started at 6am 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 rose
The chest pain of MI does not respond to rest or nitrates
Which of the following statements provides blood work results and rationale that would be most
closely associated with acute coronary syndrome? - ANSElevated creatinine kinase and
troponin, both of which normally exist intracellularly rather than in circulation
Myocardial necrosis releases creatinine kinase and troponin that normally exist intracellularly
A number of clients have presented to the emergency department in the last 32 hours with
complaints that preliminarily indicative of MI, which of the following clients is least likely to have
a STEMI? - ANSA 71-year-old man who has most skin, fever and chest pain that is excruciating
when he moves but relieved when at rest
STEMI pain not normally relieved by rest, nor would fever be a common symptom
,Following a STEMI, the nurse should be assessing the pt for which of the following
complications? - ANSLarge amount of pink, frothy sputum and new onset of murmur
A 78-year-old man has been experiencing nocturnal chest pain over the last several months,
and his family physician diagnosed him with variant angina. Which of the following teaching
points should the physician include in his explanation of the man's new diagnosis? - ANSI'm
going to start you on a low-dose aspirin, and it will help greatly if you can lose weight and keep
exercising.
An IV drug abuser walks into the ED telling the nurse that, "he is sick". He looks feverish with
flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The
assessment reveals a loud murmur. An echo was ordered that shows large vegetation growing
on his mitral valve. The patient is admitted to the ICU. The nurse will be assessing this patient
for which possible life-threatening complications? - ANSSystemic emboli, especially to the brain
Systemic emboli develop and break off the mitral valve and travel into the vascular system
A 34-year-old man who is an IV drug user has presented to the ED with malaise, abdominal
pain & lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the
department would most realistically anticipate which of the following sets of diagnostics? -
ANSEcho, blood cx and temperature.
Echo helps visualize the heart, while blood cx would confirm presence or absence of
microorganisms in the circulation, and temperature would gauge presence of infection.
A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with
heart failure that his care team has characterized as attributable to systolic dysfunction. Which
of the following assessment findings is inconsistent with his diagnosis? - ANSVentricular dilation
and wall tension are significantly lower than normal.
A nurse will be providing care for a female patient who has diagnosis of heart failure that has
been characterized as being primarily right sided. Which of the following statements best
describes the presentation that the nurse should anticipate? The client - ANShas pitting edema
to the ankles and feet bilaterally, decreased activity tolerance, and occasional right upper
quadrant pain.
The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic
pressure will result in the patient displaying which of the following clinical manifestations? -
ANSDyspnea and crackles in BL lung bases
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.
, A 77-year-old patient with a history of coronary artery disease and heart failure has arrived in
the ER with a rapid heart rate and feeling of "impending doom". Based on pathophysiologic
principles, the nurse knows the rapid heart rate could - ANSbe a result of catecholamines
released from SNS that could increase the myocardial oxygen demand
A increase in sympathetic activity by stimulation of the B-adrenergic receptors of the heart leads
to tachycardia, vasoconstriction, and arrhythmia.
A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates
specific assessment criteria related to heart failure. Which of the following criteria should the
nurses prioritize in their practice? - ANSMeasurement of urine output and mental status
assessment
Both increased and decreased urine output can be markers of heart failure, as can changes in
mental status not attributable to other factors
Mr. V has been admitted for exacerbation of his chronic heart failure (HF). When the nurse
walks into the room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty
blue. Vital signs reveal heart rate of 112, respiratory rate of 36, and pulse oximeter reading of
81%. He starts coughing up frothy pink sputum. The priority intervention is to - ANScall for
emergency assistance utilizing hospital protocol
Mr. V is experiencing acute pulmonary edema
A female older adult client has presented with a new onset of shortness of breath, and the
client's physician has ordered measurement of her brain natriuretic peptide (BNP) levels along
with other diagnostic tests. What is the most accurate rationale for the physician's choice of
bloodwork? - ANSBNP is released as a compensatory mechanism during heart failure, and
measuring it can help differentiate the client's dyspnea from a respiratory pathology
Elevated BNP levels help confirm the diagnosis of HF as opposed to respiratory etiologies
A nurse is administering morning medications to a number of patients on a medical unit. Which
of the following medication regimens is most suggestive that the patient has a diagnosis of heart
failure? - ANSDiuretic, ACE inhibitor, beta-blocker
Emergency medical technicians respond to a call to find an 80-year-old man who is showing
S/S of severe shock. Which of the following phenomena is most likely taking place? - ANSThe
man's alpha & beta-adrenergic receptors have been activated, resulting in vasoconstriction and
increased HR
Central response to all types of shock
ruling out pericarditis as a contributing pathology to the patient's health problems? - ANSA
77-year-old with diminished S3 and S4 heart tones, irregular heart rate and history of a-fib
Following cardiac surgery, the nurse suspects the patient may be developing a cardiac
tamponade. Which of the following clinical manifestations would support this diagnosis? -
ANSMuffled heart tones, narrowed pulse pressure and low BP 84/60
Cardiac tamponade results in increased intracardiac pressure, progressive limitation of
ventricular diastolic filling and decrease SV and CO
Which of the following phenomena would be most likely to accompany increased myocardial
oxygen demand? - ANSIncreased aortic pressure
Results in rise in afterload, wall tension, ultimately MVO2
Which of the following teaching points would be most appropriate for a group of older adults
who are concerned about their cardiac health? - ANSThe 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
Stable plaque is associated with obstruction of blood flow, while unstable plaque may dislodge
and result in thrombus formation
Four patients 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 patient most likely experienced myocardial infarction? - ANSAn 80-year-old woman
whose pain started at 6am 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 rose
The chest pain of MI does not respond to rest or nitrates
Which of the following statements provides blood work results and rationale that would be most
closely associated with acute coronary syndrome? - ANSElevated creatinine kinase and
troponin, both of which normally exist intracellularly rather than in circulation
Myocardial necrosis releases creatinine kinase and troponin that normally exist intracellularly
A number of clients have presented to the emergency department in the last 32 hours with
complaints that preliminarily indicative of MI, which of the following clients is least likely to have
a STEMI? - ANSA 71-year-old man who has most skin, fever and chest pain that is excruciating
when he moves but relieved when at rest
STEMI pain not normally relieved by rest, nor would fever be a common symptom
,Following a STEMI, the nurse should be assessing the pt for which of the following
complications? - ANSLarge amount of pink, frothy sputum and new onset of murmur
A 78-year-old man has been experiencing nocturnal chest pain over the last several months,
and his family physician diagnosed him with variant angina. Which of the following teaching
points should the physician include in his explanation of the man's new diagnosis? - ANSI'm
going to start you on a low-dose aspirin, and it will help greatly if you can lose weight and keep
exercising.
An IV drug abuser walks into the ED telling the nurse that, "he is sick". He looks feverish with
flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The
assessment reveals a loud murmur. An echo was ordered that shows large vegetation growing
on his mitral valve. The patient is admitted to the ICU. The nurse will be assessing this patient
for which possible life-threatening complications? - ANSSystemic emboli, especially to the brain
Systemic emboli develop and break off the mitral valve and travel into the vascular system
A 34-year-old man who is an IV drug user has presented to the ED with malaise, abdominal
pain & lethargy. The health care team wants to rule out endocarditis as a diagnosis. Staff of the
department would most realistically anticipate which of the following sets of diagnostics? -
ANSEcho, blood cx and temperature.
Echo helps visualize the heart, while blood cx would confirm presence or absence of
microorganisms in the circulation, and temperature would gauge presence of infection.
A 66-year-old obese man with diagnoses of ischemic heart disease has been diagnosed with
heart failure that his care team has characterized as attributable to systolic dysfunction. Which
of the following assessment findings is inconsistent with his diagnosis? - ANSVentricular dilation
and wall tension are significantly lower than normal.
A nurse will be providing care for a female patient who has diagnosis of heart failure that has
been characterized as being primarily right sided. Which of the following statements best
describes the presentation that the nurse should anticipate? The client - ANShas pitting edema
to the ankles and feet bilaterally, decreased activity tolerance, and occasional right upper
quadrant pain.
The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic
pressure will result in the patient displaying which of the following clinical manifestations? -
ANSDyspnea and crackles in BL lung bases
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.
, A 77-year-old patient with a history of coronary artery disease and heart failure has arrived in
the ER with a rapid heart rate and feeling of "impending doom". Based on pathophysiologic
principles, the nurse knows the rapid heart rate could - ANSbe a result of catecholamines
released from SNS that could increase the myocardial oxygen demand
A increase in sympathetic activity by stimulation of the B-adrenergic receptors of the heart leads
to tachycardia, vasoconstriction, and arrhythmia.
A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates
specific assessment criteria related to heart failure. Which of the following criteria should the
nurses prioritize in their practice? - ANSMeasurement of urine output and mental status
assessment
Both increased and decreased urine output can be markers of heart failure, as can changes in
mental status not attributable to other factors
Mr. V has been admitted for exacerbation of his chronic heart failure (HF). When the nurse
walks into the room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty
blue. Vital signs reveal heart rate of 112, respiratory rate of 36, and pulse oximeter reading of
81%. He starts coughing up frothy pink sputum. The priority intervention is to - ANScall for
emergency assistance utilizing hospital protocol
Mr. V is experiencing acute pulmonary edema
A female older adult client has presented with a new onset of shortness of breath, and the
client's physician has ordered measurement of her brain natriuretic peptide (BNP) levels along
with other diagnostic tests. What is the most accurate rationale for the physician's choice of
bloodwork? - ANSBNP is released as a compensatory mechanism during heart failure, and
measuring it can help differentiate the client's dyspnea from a respiratory pathology
Elevated BNP levels help confirm the diagnosis of HF as opposed to respiratory etiologies
A nurse is administering morning medications to a number of patients on a medical unit. Which
of the following medication regimens is most suggestive that the patient has a diagnosis of heart
failure? - ANSDiuretic, ACE inhibitor, beta-blocker
Emergency medical technicians respond to a call to find an 80-year-old man who is showing
S/S of severe shock. Which of the following phenomena is most likely taking place? - ANSThe
man's alpha & beta-adrenergic receptors have been activated, resulting in vasoconstriction and
increased HR
Central response to all types of shock
