TEST BANK FOR CLINICAL GUIDELINES IN
PRIMARY CARE 4TH EDITION HOLLIER
# TEST BANK FOR CLINICAL GUIDELINES IN PRIMARY CARE 4TH EDITION HOLLIER
## Chapter 1: Cardiovascular Disorders
---
**1. The nurse is aware that the muscle layer of the heart, which is responsible for the heart's
contraction, is the:**
a. endocardium.
b. pericardium.
c. mediastinum.
d. myocardium.
**ANS: D**
**Rationale:** The myocardium is the specialized muscle layer that allows the heart to contract. The
endocardium is the inner lining of the heart, the pericardium is the outer sac surrounding the heart, and
the mediastinum is the space in the chest where the heart is located.
---
**2. The nurse clarifies that the master pacemaker of the heart is the:**
,a. left ventricle.
b. atrioventricular (AV) node.
c. sinoatrial (SA) node.
d. bundle of His.
**ANS: C**
**Rationale:** The SA node is the master pacemaker of the heart. It initiates the electrical impulse that
causes the heart to contract. The AV node receives the impulse from the SA node, and the bundle of His
conducts the impulse to the ventricles.
---
**3. The nurse is aware that the symptoms of an impending myocardial infarction (MI) differ in women
because acute chest pain is not present. Women are frequently misdiagnosed as having:**
a. hepatitis A.
b. indigestion.
c. urinary infection.
d. menopausal complications.
**ANS: B**
**Rationale:** Indigestion, gallbladder attack, anxiety attack, and depression are frequent misdiagnoses
for women having an MI. Women often present with atypical symptoms such as nausea, fatigue, and
back pain rather than classic chest pain.
---
,**4. The nurse identifies the LUBB sound of the LUBB/DUBB of the cardiac cycle as the sound of the:**
a. AV valves closing.
b. closure of the semilunar valves.
c. contraction of the papillary muscles.
d. contraction of the ventricles.
**ANS: A**
**Rationale:** The LUBB is the first sound of a low pitch heard when the AV valves (mitral and tricuspid)
close. The DUBB is the second sound heard when the semilunar valves (aortic and pulmonic) close.
---
**5. A patient is admitted from the emergency department. The emergency department physician notes
the patient has a diagnosis of heart failure with a New York Heart Association (NYHA) classification of IV.
This indicates the patient's condition as:**
a. moderate heart failure.
b. severe heart failure.
c. congestive heart failure.
d. negligible heart failure.
**ANS: B**
**Rationale:** Class IV: Severe; patient unable to perform any physical activity without discomfort.
Angina or symptoms of cardiac inefficiency may develop at rest. Class I is mild, Class II is slight limitation,
and Class III is marked limitation.
---
, **6. The nurse assesses that the home health patient has no signs or symptoms of heart failure, but
does have a history of rheumatic fever and has been recently diagnosed with diabetes mellitus. The
nurse is aware that using the American College of Cardiology and the American Heart Association
(ACC/AHA) staging, this patient would be a:**
a. stage A.
b. stage B.
c. stage C.
d. stage D.
**ANS: A**
**Rationale:** The ACC/AHA staging describes stage A as a person without symptoms of heart failure,
but with primary conditions associated with the development of the disease (e.g., diabetes,
hypertension, rheumatic fever). Stage B includes structural heart disease but no symptoms, Stage C
includes structural heart disease with symptoms, and Stage D includes refractory heart failure.
---
**7. The nurse caring for a patient recovering from a myocardial infarct who is on remote telemetry
recognizes the need for added instruction when the patient says:**
a. "I can ambulate in the hallway with this gadget on."
b. "I always take off the telemetry device when I shower."
c. "My EKG is being watched by one of the nurses in CCU on the home unit."
d. "I am able to sleep just fine with this device on."
**ANS: B**
PRIMARY CARE 4TH EDITION HOLLIER
# TEST BANK FOR CLINICAL GUIDELINES IN PRIMARY CARE 4TH EDITION HOLLIER
## Chapter 1: Cardiovascular Disorders
---
**1. The nurse is aware that the muscle layer of the heart, which is responsible for the heart's
contraction, is the:**
a. endocardium.
b. pericardium.
c. mediastinum.
d. myocardium.
**ANS: D**
**Rationale:** The myocardium is the specialized muscle layer that allows the heart to contract. The
endocardium is the inner lining of the heart, the pericardium is the outer sac surrounding the heart, and
the mediastinum is the space in the chest where the heart is located.
---
**2. The nurse clarifies that the master pacemaker of the heart is the:**
,a. left ventricle.
b. atrioventricular (AV) node.
c. sinoatrial (SA) node.
d. bundle of His.
**ANS: C**
**Rationale:** The SA node is the master pacemaker of the heart. It initiates the electrical impulse that
causes the heart to contract. The AV node receives the impulse from the SA node, and the bundle of His
conducts the impulse to the ventricles.
---
**3. The nurse is aware that the symptoms of an impending myocardial infarction (MI) differ in women
because acute chest pain is not present. Women are frequently misdiagnosed as having:**
a. hepatitis A.
b. indigestion.
c. urinary infection.
d. menopausal complications.
**ANS: B**
**Rationale:** Indigestion, gallbladder attack, anxiety attack, and depression are frequent misdiagnoses
for women having an MI. Women often present with atypical symptoms such as nausea, fatigue, and
back pain rather than classic chest pain.
---
,**4. The nurse identifies the LUBB sound of the LUBB/DUBB of the cardiac cycle as the sound of the:**
a. AV valves closing.
b. closure of the semilunar valves.
c. contraction of the papillary muscles.
d. contraction of the ventricles.
**ANS: A**
**Rationale:** The LUBB is the first sound of a low pitch heard when the AV valves (mitral and tricuspid)
close. The DUBB is the second sound heard when the semilunar valves (aortic and pulmonic) close.
---
**5. A patient is admitted from the emergency department. The emergency department physician notes
the patient has a diagnosis of heart failure with a New York Heart Association (NYHA) classification of IV.
This indicates the patient's condition as:**
a. moderate heart failure.
b. severe heart failure.
c. congestive heart failure.
d. negligible heart failure.
**ANS: B**
**Rationale:** Class IV: Severe; patient unable to perform any physical activity without discomfort.
Angina or symptoms of cardiac inefficiency may develop at rest. Class I is mild, Class II is slight limitation,
and Class III is marked limitation.
---
, **6. The nurse assesses that the home health patient has no signs or symptoms of heart failure, but
does have a history of rheumatic fever and has been recently diagnosed with diabetes mellitus. The
nurse is aware that using the American College of Cardiology and the American Heart Association
(ACC/AHA) staging, this patient would be a:**
a. stage A.
b. stage B.
c. stage C.
d. stage D.
**ANS: A**
**Rationale:** The ACC/AHA staging describes stage A as a person without symptoms of heart failure,
but with primary conditions associated with the development of the disease (e.g., diabetes,
hypertension, rheumatic fever). Stage B includes structural heart disease but no symptoms, Stage C
includes structural heart disease with symptoms, and Stage D includes refractory heart failure.
---
**7. The nurse caring for a patient recovering from a myocardial infarct who is on remote telemetry
recognizes the need for added instruction when the patient says:**
a. "I can ambulate in the hallway with this gadget on."
b. "I always take off the telemetry device when I shower."
c. "My EKG is being watched by one of the nurses in CCU on the home unit."
d. "I am able to sleep just fine with this device on."
**ANS: B**
