MEDICAL SURGICAL EXAM 1
REVIEWED QUESTIONS AND ANSWERS
A patient is seen at the clinic for a routine physical examination. After the patient is
assessed for evidence of peripheral vascular disease, the nurse explains that which of
the following tests is typically used to assist in the diagnosis?
1. Allen's Test
2. Ankle brachial pressure index.
3. Cardiac Stress Test.
4. Echocardiogram - CORRECT ANSWER-2. Ankle brachial pressure index.
Rationale: The ankle brachial index (ABI) is the blood pressure ratio between the lower
legs and the arms. Blood pressure in the legs is normally higher than the arms, and
abnormalities indicate narrowing of the arteries. Clinical findings that may suggest the
presence of PVD includes a history of angina with activity, intermittent claudication, and
abnormal (weak or absent) pedal pulses. The formula for ABI is the systolic blood
pressure of the ankle (measured at the dorsalis pedis or posterior tibial arteries) divided
by the systolic pressure in the arms. It is measured on both sides. A ratio of 1.0
indicates peripheral vascular disease. Incorrect: Allen's test is used to assess blood
supply to the hand.Incorrect: Cardiac stress tests are used to measure the heart's ability
to respond to stress. Incorrect: ECG evaluates the structure and function of the heart
muscle, but does not tell if there is peripheral vascular disease present.
A patient has been diagnosed with left-sided congestive heart failure, and is confused
about the return of oxygenated blood from the lungs. To clarify the confusion, the nurse
explains all chambers of the heart dealing with blood circulation. The nurse is correct
when she tells the client:
1. A muscular space called the pericardial space separates the chambers of the right
side from the left side.
2. Blood flows into the left ventricle which pumps it out against high resistance into the
systemic circulation.
3. The blood moves to the left ventricle, which pumps blood into the lungs.
3. The heart consists of 5 chambers.
4. The left atrium receives oxygenated blood from the lungs.
5. The right atrium receives deoxygenated blood from the body tissues. - CORRECT
‘ANSWER-2. ‘Blood ‘flows ‘into ‘the ‘left ‘ventricle ‘which ‘pumps ‘it ‘out ‘against ‘high
‘resistance ‘into ‘the ‘systemic ‘circulation.
,3. The ‘blood ‘moves ‘to ‘the ‘left ‘ventricle, ‘which ‘pumps ‘blood ‘into ‘the ‘lungs.
4. The ‘left ‘atrium ‘receives ‘oxygenated ‘blood ‘from ‘the ‘lungs.
5. The ‘right ‘atrium ‘receives ‘deoxygenated ‘blood ‘from ‘the ‘body ‘tissues.
Rationale: ‘Heart ‘consists ‘of ‘4 ‘chambers: ‘2 ‘atria ‘and ‘2 ‘ventricles. ‘The ‘right ‘and ‘left
‘chambers ‘are ‘separated ‘down ‘the ‘middle ‘of ‘the ‘heart ‘by ‘a ‘septum, ‘like ‘a ‘wall. ‘The
‘right ‘atrium ‘receives ‘deoxygenated ‘from ‘the ‘body, ‘and ‘the ‘blood ‘then ‘moves ‘down
‘into ‘the ‘right ‘ventricle, ‘which ‘pumps ‘it ‘to ‘the ‘lungs ‘with ‘low ‘resistance. ‘The ‘left ‘atrium
‘then ‘receives ‘oxygenated ‘blood ‘from ‘the ‘lungs, ‘and ‘that ‘blood ‘moves ‘down ‘into ‘the
‘left ‘ventricle. ‘The ‘left ‘ventricle, ‘which ‘is ‘the ‘most ‘muscular ‘chamber, ‘pumps ‘oxygen
‘rich ‘blood ‘into ‘the ‘systemic ‘circulation.
A ‘patient ‘recovering ‘from ‘a ‘MI ‘has ‘been ‘in ‘bed ‘for ‘6 ‘days. ‘The ‘patient ‘now ‘complains
‘of ‘calf ‘pain. ‘The ‘nurse ‘should ‘first:
1. Administer ‘pain ‘medication ‘as ‘ordered.
2. Assess ‘the ‘calf ‘for ‘redness ‘warmth ‘and ‘swelling.
3. Massage ‘the ‘calf ‘to ‘relieve ‘the ‘muscle ‘cramp.
Observe ‘the ‘patient ‘walking. ‘- ‘CORRECT ‘ANSWER-2. ‘Assess ‘the ‘calf ‘for ‘redness
‘warmth ‘and ‘swelling.
Rationale: ‘Due ‘to ‘the ‘time ‘spend ‘in ‘bed ‘and ‘inactive, ‘the ‘patient ‘is ‘at ‘high ‘risk ‘for ‘the
‘development ‘of ‘a ‘DVT. ‘Pain ‘in ‘the ‘calf, ‘redness ‘or ‘heat, ‘and ‘swelling ‘in ‘the ‘affected
‘extremity ‘are ‘signs ‘of ‘a ‘DVT. ‘Diagnostic ‘tests ‘that ‘help ‘diagnose ‘a ‘DVT ‘include ‘a ‘D-
‘dimer ‘test ‘to ‘confirm ‘the ‘presence ‘of ‘fibrin ‘degradation ‘in ‘products ‘from ‘a ‘clot,
‘venous ‘ultrasound, ‘venography ‘to ‘visualize ‘the ‘clot ‘with ‘contrast, ‘or ‘less ‘commonly
‘MRI ‘or ‘CT.
The ‘nurse ‘is ‘caring ‘for ‘a ‘patient ‘in ‘the ‘early ‘stages ‘of ‘heart ‘failure. ‘The ‘family ‘is
‘curious ‘as ‘to ‘how ‘the ‘body ‘adapts ‘to ‘heart ‘failure. ‘The ‘nurse ‘knows ‘that ‘during ‘the
‘early ‘stages ‘of ‘heart ‘failure, ‘which ‘specific ‘compensatory ‘mechanisms ‘occur?
1. Decreased ‘cardiac ‘output ‘inhibits ‘the ‘release ‘of ‘ADH ‘by ‘the ‘pituitary ‘gland.
2. Hypotension ‘stimulates ‘the ‘baroreceptors ‘to ‘increase ‘sympathetic ‘activity.
3. Hypotension ‘stimulates ‘the ‘baroreceptors ‘to ‘decrease ‘sympathetic ‘activity.
4. Impaired ‘renal ‘perfusion ‘inhibits ‘aldosterone ‘release. ‘- ‘CORRECT ‘ANSWER-
2. ‘Hypotension ‘stimulates ‘the ‘baroreceptors ‘to ‘increase ‘sympathetic ‘activity.
Rationale: ‘As ‘arterial ‘blood ‘pressure ‘falls, ‘the ‘baroreceptors ‘of ‘the ‘carotid ‘and ‘aorta
‘are ‘stimulated. ‘This ‘causes ‘a ‘sympathetic ‘release ‘of ‘catecholamines, ‘resulting ‘in
‘vasoconstriction ‘and ‘an ‘increased ‘heart ‘rate ‘to ‘compensate. ‘The ‘compensatory
‘mechanism ‘increases ‘peripheral ‘vascular ‘resistance ‘and ‘also ‘the ‘work ‘load ‘of ‘the
‘heart. ‘This ‘can ‘worsen ‘heart ‘failure ‘if ‘not ‘treated.
Incorrect: ‘Decreased ‘cardiac ‘output ‘will ‘INCREASE ‘ADH ‘release, ‘leading ‘to ‘fluid
‘retention.
Incorrect: ‘Impaired ‘renal ‘perfusion ‘will ‘stimulate ‘aldosterone ‘release ‘leading ‘to ‘addition
‘fluid ‘and ‘sodium ‘retention.
,The ‘nurse ‘is ‘assessing ‘a ‘patient ‘with ‘atrial ‘fibrillation ‘and ‘a ‘rapid ‘ventricular ‘rate. ‘The
‘nurse ‘would ‘expect ‘to ‘see:
1. Distended ‘juglar ‘veins.
2. Dizziness ‘and ‘hypotension.
3. Hypertension ‘and ‘headache.
4. Lower ‘extremity ‘pain. ‘- ‘CORRECT ‘ANSWER-2. ‘Dizziness ‘and ‘hypotension.
Rationale: ‘Atrial ‘fibrillation ‘is ‘any ‘arrhythmia ‘in ‘which ‘the ‘atria ‘initiate ‘rapid, ‘ineffective
‘contractions ‘that ‘are ‘not ‘synchronized ‘with ‘ventricular ‘contractions. ‘This ‘patient ‘has
‘uncontrolled ‘atrial ‘fibrillation, ‘which ‘can ‘result ‘in ‘a ‘low ‘cardiac ‘output. ‘Signs ‘and
‘symptoms ‘of ‘a ‘low ‘cardiac ‘output ‘include ‘hypotension, ‘dizziness, ‘weakness, ‘fatigue,
‘shortness ‘of ‘breath, ‘and ‘syncope.
The ‘nurse ‘is ‘caring ‘for ‘a ‘patient ‘scheduled ‘to ‘undergo ‘a ‘mitral ‘valve ‘replacement. ‘The
‘nurse ‘should ‘monitor ‘for ‘which ‘complication ‘of ‘mitral ‘stenosis?
1. Left-sided ‘heart ‘failure.
2. MI
3. Pulmonary ‘Hypertension
4. Respiratory ‘Alkalosis ‘- ‘CORRECT ‘ANSWER-3. ‘Pulmonary ‘Hypertension
Rationale: ‘Mitral ‘stenosis ‘impeded ‘blood ‘flow ‘from ‘the ‘left ‘atrium ‘to ‘the ‘left ‘ventricle ‘of
‘the ‘heart. ‘This ‘creates ‘increased ‘pulmonary ‘vascular ‘resistance, ‘causing ‘pulmonary
‘hypertension. ‘Other ‘complications ‘of ‘mitral ‘stenosis ‘include ‘edema, ‘right-sided ‘heart
‘failure, ‘and ‘reduced ‘cardiac ‘output.
A ‘nurse ‘is ‘assessing ‘a ‘patient ‘who ‘has ‘longstanding ‘hypertension. ‘The ‘nurse ‘know
‘that ‘complications ‘of ‘hypertension ‘are ‘possibly ‘arising ‘when ‘which ‘of ‘the ‘following
‘signs ‘are ‘noted?
1. Dyspnea ‘during ‘activity
2. Fatigability
3. Recurrent ‘episodes ‘of ‘severe ‘headache.
4. Trace ‘proteins ‘in ‘the ‘urinalysis. ‘- ‘CORRECT ‘ANSWER-4. ‘Trace ‘proteins ‘in
‘the ‘urinalysis.
Proteinuria ‘and ‘albuminuria ‘are ‘early ‘indications ‘of ‘renal ‘injury, ‘a ‘serious ‘complication
‘that ‘can ‘be ‘caused ‘by ‘hypertension. ‘High ‘pressures ‘damage ‘the ‘kidney's ‘ability ‘to
‘filter ‘toxins, ‘and ‘evidence ‘of ‘this ‘damage ‘is ‘seen ‘as ‘proteins ‘leak ‘out ‘of ‘the ‘urine.
‘The ‘other ‘choices ‘are ‘not ‘direct ‘indicators ‘of ‘progressive ‘disease ‘or ‘complications.
‘Fatigability ‘and ‘headache ‘are ‘symptoms ‘of ‘hypertension ‘but ‘are ‘not ‘direct ‘indicators
‘of ‘progressive ‘disease ‘or ‘complications. ‘These ‘may ‘be ‘side ‘effects ‘of ‘certain
‘medications ‘used ‘to ‘ treat ‘hypertension. ‘Dyspnea ‘during ‘activity ‘is ‘NOT ‘associated
‘with ‘hypertension.
Dyspnea ‘can ‘be ‘a ‘sign ‘of ‘low ‘cardiac ‘output ‘(congestive ‘heart ‘failure), ‘pulmonary
‘edema, ‘severe ‘anemia, ‘or ‘a ‘respiratory ‘problem ‘(asthma, ‘pneumonia, ‘etc.). ‘;./
, The ‘nurse ‘is ‘evaluating ‘a ‘52 ‘year ‘old ‘male ‘for ‘risk ‘factors ‘for ‘CAD. ‘The ‘patient ‘is
‘overweight, ‘male, ‘and ‘smokes ‘a ‘pack ‘a ‘day. ‘The ‘nurse ‘questions ‘the ‘patient ‘about
‘other ‘risk ‘factors ‘including:
1) A ‘history ‘of ‘atherosclerotic ‘heart ‘disease.
2) A ‘history ‘of ‘diabetes.
3) A ‘history ‘of ‘gout.
4) Elevated ‘HDL ‘levels. ‘- ‘CORRECT ‘ANSWER-2) ‘A ‘history ‘of ‘diabetes.
Rationale: ‘The ‘major ‘risk ‘factors ‘for ‘CAD ‘are ‘diabetes, ‘smoking, ‘increased ‘LDL
‘levels, ‘and ‘hypertension. ‘Elevated ‘HDL ‘levels ‘are ‘PROTECTIVE ‘against ‘CAD.
‘Atherosclerotic ‘heart ‘disease ‘is ‘just ‘another ‘name ‘for ‘coronary ‘heart ‘disease. ‘Gout ‘is
‘not ‘associated ‘with ‘CAD.
The ‘nurse ‘is ‘knowledgeable ‘about ‘sinoatrial ‘node ‘dysrhythmias ‘if ‘she ‘selects ‘which ‘of
‘the ‘following ‘causes ‘of ‘sinus ‘tachycardia? ‘Select ‘all ‘that ‘apply.
1. Emotional ‘and ‘physical ‘stress
2. Fever
3. Heart ‘Failure
4. Increased ‘Intracranial ‘pressure
5. Infection
6. MI ‘- ‘CORRECT ‘ANSWER-1. ‘Emotional ‘and ‘physical ‘stress
2. ‘Fever
3. ‘Heart ‘Failure
5. ‘Infection
Rationale: ‘Sinus ‘tachycardia ‘is ‘defined ‘as ‘sinus ‘rhythm ‘with ‘a ‘rate ‘greater ‘than ‘100
‘beats ‘per ‘minute. ‘Causes ‘of ‘ST ‘include: ‘fever, ‘emotional ‘& ‘physical ‘stress, ‘heart
‘failure, ‘fluid ‘volume ‘loss, ‘hyperthyroidism, ‘hypercalcemia, ‘caffeine, ‘nicotine, ‘exercise,
‘and ‘some ‘medications. ‘In ‘the ‘vast ‘majority ‘of ‘cases, ‘sinus ‘tachycardia ‘results ‘from
‘some ‘underlying ‘condition ‘such ‘as ‘exercise, ‘infection, ‘or ‘congestive ‘heart ‘failure,
‘which ‘alters ‘the ‘autonomic ‘nervous ‘system. ‘Sinus ‘bradycardia ‘may ‘result ‘from ‘the
‘following: ‘Valsalva's ‘maneuver, ‘drugs ‘like ‘digitalis, ‘MI, ‘hyperkalemia, ‘hypothyroidism,
‘severe ‘hypoxia, ‘and ‘increased ‘ICP.
The ‘nurse ‘is ‘auscultating ‘the ‘heart ‘of ‘a ‘patient ‘with ‘congestive ‘heart ‘failure. ‘The ‘nurse
‘hears ‘an ‘extra ‘sound ‘with ‘a ‘very ‘low ‘pitch, ‘immediately ‘after ‘the ‘2nd ‘heart ‘sound ‘S2.
‘The ‘nurse ‘interprets ‘this ‘as:
1. A ‘murmur ‘due ‘to ‘an ‘aortic ‘regurgitation.
2. A ‘split ‘S1.
3. A ‘split ‘S2.
4. A ‘third ‘heart ‘sound ‘(S3). ‘- ‘CORRECT ‘ANSWER-Rationale: ‘S3 ‘occurs ‘immediately
‘after ‘S2. ‘It ‘has ‘a ‘very ‘low ‘pitch ‘and ‘has ‘been ‘described ‘as ‘a ‘"gallop" ‘or ‘vibration. ‘It
‘can ‘occur ‘normally ‘in ‘people ‘under ‘40 ‘and ‘in ‘athletes. ‘Later ‘in ‘life, ‘it ‘may ‘indicate
‘heart ‘failure ‘(ventricular ‘dysfunction) ‘and/or ‘fluid ‘overload.
REVIEWED QUESTIONS AND ANSWERS
A patient is seen at the clinic for a routine physical examination. After the patient is
assessed for evidence of peripheral vascular disease, the nurse explains that which of
the following tests is typically used to assist in the diagnosis?
1. Allen's Test
2. Ankle brachial pressure index.
3. Cardiac Stress Test.
4. Echocardiogram - CORRECT ANSWER-2. Ankle brachial pressure index.
Rationale: The ankle brachial index (ABI) is the blood pressure ratio between the lower
legs and the arms. Blood pressure in the legs is normally higher than the arms, and
abnormalities indicate narrowing of the arteries. Clinical findings that may suggest the
presence of PVD includes a history of angina with activity, intermittent claudication, and
abnormal (weak or absent) pedal pulses. The formula for ABI is the systolic blood
pressure of the ankle (measured at the dorsalis pedis or posterior tibial arteries) divided
by the systolic pressure in the arms. It is measured on both sides. A ratio of 1.0
indicates peripheral vascular disease. Incorrect: Allen's test is used to assess blood
supply to the hand.Incorrect: Cardiac stress tests are used to measure the heart's ability
to respond to stress. Incorrect: ECG evaluates the structure and function of the heart
muscle, but does not tell if there is peripheral vascular disease present.
A patient has been diagnosed with left-sided congestive heart failure, and is confused
about the return of oxygenated blood from the lungs. To clarify the confusion, the nurse
explains all chambers of the heart dealing with blood circulation. The nurse is correct
when she tells the client:
1. A muscular space called the pericardial space separates the chambers of the right
side from the left side.
2. Blood flows into the left ventricle which pumps it out against high resistance into the
systemic circulation.
3. The blood moves to the left ventricle, which pumps blood into the lungs.
3. The heart consists of 5 chambers.
4. The left atrium receives oxygenated blood from the lungs.
5. The right atrium receives deoxygenated blood from the body tissues. - CORRECT
‘ANSWER-2. ‘Blood ‘flows ‘into ‘the ‘left ‘ventricle ‘which ‘pumps ‘it ‘out ‘against ‘high
‘resistance ‘into ‘the ‘systemic ‘circulation.
,3. The ‘blood ‘moves ‘to ‘the ‘left ‘ventricle, ‘which ‘pumps ‘blood ‘into ‘the ‘lungs.
4. The ‘left ‘atrium ‘receives ‘oxygenated ‘blood ‘from ‘the ‘lungs.
5. The ‘right ‘atrium ‘receives ‘deoxygenated ‘blood ‘from ‘the ‘body ‘tissues.
Rationale: ‘Heart ‘consists ‘of ‘4 ‘chambers: ‘2 ‘atria ‘and ‘2 ‘ventricles. ‘The ‘right ‘and ‘left
‘chambers ‘are ‘separated ‘down ‘the ‘middle ‘of ‘the ‘heart ‘by ‘a ‘septum, ‘like ‘a ‘wall. ‘The
‘right ‘atrium ‘receives ‘deoxygenated ‘from ‘the ‘body, ‘and ‘the ‘blood ‘then ‘moves ‘down
‘into ‘the ‘right ‘ventricle, ‘which ‘pumps ‘it ‘to ‘the ‘lungs ‘with ‘low ‘resistance. ‘The ‘left ‘atrium
‘then ‘receives ‘oxygenated ‘blood ‘from ‘the ‘lungs, ‘and ‘that ‘blood ‘moves ‘down ‘into ‘the
‘left ‘ventricle. ‘The ‘left ‘ventricle, ‘which ‘is ‘the ‘most ‘muscular ‘chamber, ‘pumps ‘oxygen
‘rich ‘blood ‘into ‘the ‘systemic ‘circulation.
A ‘patient ‘recovering ‘from ‘a ‘MI ‘has ‘been ‘in ‘bed ‘for ‘6 ‘days. ‘The ‘patient ‘now ‘complains
‘of ‘calf ‘pain. ‘The ‘nurse ‘should ‘first:
1. Administer ‘pain ‘medication ‘as ‘ordered.
2. Assess ‘the ‘calf ‘for ‘redness ‘warmth ‘and ‘swelling.
3. Massage ‘the ‘calf ‘to ‘relieve ‘the ‘muscle ‘cramp.
Observe ‘the ‘patient ‘walking. ‘- ‘CORRECT ‘ANSWER-2. ‘Assess ‘the ‘calf ‘for ‘redness
‘warmth ‘and ‘swelling.
Rationale: ‘Due ‘to ‘the ‘time ‘spend ‘in ‘bed ‘and ‘inactive, ‘the ‘patient ‘is ‘at ‘high ‘risk ‘for ‘the
‘development ‘of ‘a ‘DVT. ‘Pain ‘in ‘the ‘calf, ‘redness ‘or ‘heat, ‘and ‘swelling ‘in ‘the ‘affected
‘extremity ‘are ‘signs ‘of ‘a ‘DVT. ‘Diagnostic ‘tests ‘that ‘help ‘diagnose ‘a ‘DVT ‘include ‘a ‘D-
‘dimer ‘test ‘to ‘confirm ‘the ‘presence ‘of ‘fibrin ‘degradation ‘in ‘products ‘from ‘a ‘clot,
‘venous ‘ultrasound, ‘venography ‘to ‘visualize ‘the ‘clot ‘with ‘contrast, ‘or ‘less ‘commonly
‘MRI ‘or ‘CT.
The ‘nurse ‘is ‘caring ‘for ‘a ‘patient ‘in ‘the ‘early ‘stages ‘of ‘heart ‘failure. ‘The ‘family ‘is
‘curious ‘as ‘to ‘how ‘the ‘body ‘adapts ‘to ‘heart ‘failure. ‘The ‘nurse ‘knows ‘that ‘during ‘the
‘early ‘stages ‘of ‘heart ‘failure, ‘which ‘specific ‘compensatory ‘mechanisms ‘occur?
1. Decreased ‘cardiac ‘output ‘inhibits ‘the ‘release ‘of ‘ADH ‘by ‘the ‘pituitary ‘gland.
2. Hypotension ‘stimulates ‘the ‘baroreceptors ‘to ‘increase ‘sympathetic ‘activity.
3. Hypotension ‘stimulates ‘the ‘baroreceptors ‘to ‘decrease ‘sympathetic ‘activity.
4. Impaired ‘renal ‘perfusion ‘inhibits ‘aldosterone ‘release. ‘- ‘CORRECT ‘ANSWER-
2. ‘Hypotension ‘stimulates ‘the ‘baroreceptors ‘to ‘increase ‘sympathetic ‘activity.
Rationale: ‘As ‘arterial ‘blood ‘pressure ‘falls, ‘the ‘baroreceptors ‘of ‘the ‘carotid ‘and ‘aorta
‘are ‘stimulated. ‘This ‘causes ‘a ‘sympathetic ‘release ‘of ‘catecholamines, ‘resulting ‘in
‘vasoconstriction ‘and ‘an ‘increased ‘heart ‘rate ‘to ‘compensate. ‘The ‘compensatory
‘mechanism ‘increases ‘peripheral ‘vascular ‘resistance ‘and ‘also ‘the ‘work ‘load ‘of ‘the
‘heart. ‘This ‘can ‘worsen ‘heart ‘failure ‘if ‘not ‘treated.
Incorrect: ‘Decreased ‘cardiac ‘output ‘will ‘INCREASE ‘ADH ‘release, ‘leading ‘to ‘fluid
‘retention.
Incorrect: ‘Impaired ‘renal ‘perfusion ‘will ‘stimulate ‘aldosterone ‘release ‘leading ‘to ‘addition
‘fluid ‘and ‘sodium ‘retention.
,The ‘nurse ‘is ‘assessing ‘a ‘patient ‘with ‘atrial ‘fibrillation ‘and ‘a ‘rapid ‘ventricular ‘rate. ‘The
‘nurse ‘would ‘expect ‘to ‘see:
1. Distended ‘juglar ‘veins.
2. Dizziness ‘and ‘hypotension.
3. Hypertension ‘and ‘headache.
4. Lower ‘extremity ‘pain. ‘- ‘CORRECT ‘ANSWER-2. ‘Dizziness ‘and ‘hypotension.
Rationale: ‘Atrial ‘fibrillation ‘is ‘any ‘arrhythmia ‘in ‘which ‘the ‘atria ‘initiate ‘rapid, ‘ineffective
‘contractions ‘that ‘are ‘not ‘synchronized ‘with ‘ventricular ‘contractions. ‘This ‘patient ‘has
‘uncontrolled ‘atrial ‘fibrillation, ‘which ‘can ‘result ‘in ‘a ‘low ‘cardiac ‘output. ‘Signs ‘and
‘symptoms ‘of ‘a ‘low ‘cardiac ‘output ‘include ‘hypotension, ‘dizziness, ‘weakness, ‘fatigue,
‘shortness ‘of ‘breath, ‘and ‘syncope.
The ‘nurse ‘is ‘caring ‘for ‘a ‘patient ‘scheduled ‘to ‘undergo ‘a ‘mitral ‘valve ‘replacement. ‘The
‘nurse ‘should ‘monitor ‘for ‘which ‘complication ‘of ‘mitral ‘stenosis?
1. Left-sided ‘heart ‘failure.
2. MI
3. Pulmonary ‘Hypertension
4. Respiratory ‘Alkalosis ‘- ‘CORRECT ‘ANSWER-3. ‘Pulmonary ‘Hypertension
Rationale: ‘Mitral ‘stenosis ‘impeded ‘blood ‘flow ‘from ‘the ‘left ‘atrium ‘to ‘the ‘left ‘ventricle ‘of
‘the ‘heart. ‘This ‘creates ‘increased ‘pulmonary ‘vascular ‘resistance, ‘causing ‘pulmonary
‘hypertension. ‘Other ‘complications ‘of ‘mitral ‘stenosis ‘include ‘edema, ‘right-sided ‘heart
‘failure, ‘and ‘reduced ‘cardiac ‘output.
A ‘nurse ‘is ‘assessing ‘a ‘patient ‘who ‘has ‘longstanding ‘hypertension. ‘The ‘nurse ‘know
‘that ‘complications ‘of ‘hypertension ‘are ‘possibly ‘arising ‘when ‘which ‘of ‘the ‘following
‘signs ‘are ‘noted?
1. Dyspnea ‘during ‘activity
2. Fatigability
3. Recurrent ‘episodes ‘of ‘severe ‘headache.
4. Trace ‘proteins ‘in ‘the ‘urinalysis. ‘- ‘CORRECT ‘ANSWER-4. ‘Trace ‘proteins ‘in
‘the ‘urinalysis.
Proteinuria ‘and ‘albuminuria ‘are ‘early ‘indications ‘of ‘renal ‘injury, ‘a ‘serious ‘complication
‘that ‘can ‘be ‘caused ‘by ‘hypertension. ‘High ‘pressures ‘damage ‘the ‘kidney's ‘ability ‘to
‘filter ‘toxins, ‘and ‘evidence ‘of ‘this ‘damage ‘is ‘seen ‘as ‘proteins ‘leak ‘out ‘of ‘the ‘urine.
‘The ‘other ‘choices ‘are ‘not ‘direct ‘indicators ‘of ‘progressive ‘disease ‘or ‘complications.
‘Fatigability ‘and ‘headache ‘are ‘symptoms ‘of ‘hypertension ‘but ‘are ‘not ‘direct ‘indicators
‘of ‘progressive ‘disease ‘or ‘complications. ‘These ‘may ‘be ‘side ‘effects ‘of ‘certain
‘medications ‘used ‘to ‘ treat ‘hypertension. ‘Dyspnea ‘during ‘activity ‘is ‘NOT ‘associated
‘with ‘hypertension.
Dyspnea ‘can ‘be ‘a ‘sign ‘of ‘low ‘cardiac ‘output ‘(congestive ‘heart ‘failure), ‘pulmonary
‘edema, ‘severe ‘anemia, ‘or ‘a ‘respiratory ‘problem ‘(asthma, ‘pneumonia, ‘etc.). ‘;./
, The ‘nurse ‘is ‘evaluating ‘a ‘52 ‘year ‘old ‘male ‘for ‘risk ‘factors ‘for ‘CAD. ‘The ‘patient ‘is
‘overweight, ‘male, ‘and ‘smokes ‘a ‘pack ‘a ‘day. ‘The ‘nurse ‘questions ‘the ‘patient ‘about
‘other ‘risk ‘factors ‘including:
1) A ‘history ‘of ‘atherosclerotic ‘heart ‘disease.
2) A ‘history ‘of ‘diabetes.
3) A ‘history ‘of ‘gout.
4) Elevated ‘HDL ‘levels. ‘- ‘CORRECT ‘ANSWER-2) ‘A ‘history ‘of ‘diabetes.
Rationale: ‘The ‘major ‘risk ‘factors ‘for ‘CAD ‘are ‘diabetes, ‘smoking, ‘increased ‘LDL
‘levels, ‘and ‘hypertension. ‘Elevated ‘HDL ‘levels ‘are ‘PROTECTIVE ‘against ‘CAD.
‘Atherosclerotic ‘heart ‘disease ‘is ‘just ‘another ‘name ‘for ‘coronary ‘heart ‘disease. ‘Gout ‘is
‘not ‘associated ‘with ‘CAD.
The ‘nurse ‘is ‘knowledgeable ‘about ‘sinoatrial ‘node ‘dysrhythmias ‘if ‘she ‘selects ‘which ‘of
‘the ‘following ‘causes ‘of ‘sinus ‘tachycardia? ‘Select ‘all ‘that ‘apply.
1. Emotional ‘and ‘physical ‘stress
2. Fever
3. Heart ‘Failure
4. Increased ‘Intracranial ‘pressure
5. Infection
6. MI ‘- ‘CORRECT ‘ANSWER-1. ‘Emotional ‘and ‘physical ‘stress
2. ‘Fever
3. ‘Heart ‘Failure
5. ‘Infection
Rationale: ‘Sinus ‘tachycardia ‘is ‘defined ‘as ‘sinus ‘rhythm ‘with ‘a ‘rate ‘greater ‘than ‘100
‘beats ‘per ‘minute. ‘Causes ‘of ‘ST ‘include: ‘fever, ‘emotional ‘& ‘physical ‘stress, ‘heart
‘failure, ‘fluid ‘volume ‘loss, ‘hyperthyroidism, ‘hypercalcemia, ‘caffeine, ‘nicotine, ‘exercise,
‘and ‘some ‘medications. ‘In ‘the ‘vast ‘majority ‘of ‘cases, ‘sinus ‘tachycardia ‘results ‘from
‘some ‘underlying ‘condition ‘such ‘as ‘exercise, ‘infection, ‘or ‘congestive ‘heart ‘failure,
‘which ‘alters ‘the ‘autonomic ‘nervous ‘system. ‘Sinus ‘bradycardia ‘may ‘result ‘from ‘the
‘following: ‘Valsalva's ‘maneuver, ‘drugs ‘like ‘digitalis, ‘MI, ‘hyperkalemia, ‘hypothyroidism,
‘severe ‘hypoxia, ‘and ‘increased ‘ICP.
The ‘nurse ‘is ‘auscultating ‘the ‘heart ‘of ‘a ‘patient ‘with ‘congestive ‘heart ‘failure. ‘The ‘nurse
‘hears ‘an ‘extra ‘sound ‘with ‘a ‘very ‘low ‘pitch, ‘immediately ‘after ‘the ‘2nd ‘heart ‘sound ‘S2.
‘The ‘nurse ‘interprets ‘this ‘as:
1. A ‘murmur ‘due ‘to ‘an ‘aortic ‘regurgitation.
2. A ‘split ‘S1.
3. A ‘split ‘S2.
4. A ‘third ‘heart ‘sound ‘(S3). ‘- ‘CORRECT ‘ANSWER-Rationale: ‘S3 ‘occurs ‘immediately
‘after ‘S2. ‘It ‘has ‘a ‘very ‘low ‘pitch ‘and ‘has ‘been ‘described ‘as ‘a ‘"gallop" ‘or ‘vibration. ‘It
‘can ‘occur ‘normally ‘in ‘people ‘under ‘40 ‘and ‘in ‘athletes. ‘Later ‘in ‘life, ‘it ‘may ‘indicate
‘heart ‘failure ‘(ventricular ‘dysfunction) ‘and/or ‘fluid ‘overload.
