A 34-year-old man who is an intravenous drug user has presented to the emergency department with malaise, abdominal pain, and 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?
CT of the heart, chest x-ray, and ECG
ECG, blood pressure, and stress test
Cardiac catheterization, chest x-ray, electrolyte measurement, and white cell count
Echocardiogram, blood cultures, and temperature
A client has been diagnosed with mitral valve stenosis following his recovery from rheumatic fever. Which of the following teaching points would be most accurate to convey to the client?
Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation
The valve between your left ventricle and left atria is infected and isn't allowing enough blood through.
Your heart's mitral valve isn't closing properly so blood is flowing backward in your heart and eventually into your lungs.
The normal tissue that makes up the valve between the right sides of your heart has stiffened
On a routine physical exam visit, the physician mentions that he hears a new murmur. The patient gets worried and asks, What does this mean? The physician responds,
It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit.
This may make you a little more fatigued than usual. Let me know if you start getting dizzy or light-headed.
This could be caused by an infection. Have you been feeling well the past few weeks?
One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problem.
A 13-year-old boy has had a sore throat for at least a week and has been vomiting for 2 days. His glands are swollen, and he moves stiffly because his joints hurt. Throat cultures show infection with group A streptococci. This child is at high risk for
infective endocarditis
vasculitis
myocarditis
mitral valve stenosis.
A physician has ordered the measurement of a cardiac patient's electrolyte levels as part of the client's morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient's heart?
The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential.
The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions.
Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.
Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation.
A 63-year-old male client has been diagnosed with a bundle branch block. How will this client's care team most likely expect his condition to be expressed diagnostically?
His ECG will show a flattened P wave as a result of impaired atrial depolarization.
Conduction from the Purkinje fibers to the bundle branches is compromised by inadequate conduction
His ECG will show an inordinately wide QRS complex because impulses are bypassing the normal conduction tissue.
His AV node will be performing the primary pacemaker role due to inadequacy of the SA node.
Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation.
The normal tissue that makes up the valve between the right sides of your heart has stiffened.
You are looking after a 61-year-old male client in the hospital who has presented with a new onset of atrial fibrillation. Which of the following courses of treatment would you most likely expect the attending physician to initiate?
Antihypertensives and constant cardiac monitoring in a high acuity unit
Immediate cardioversion followed by surgery to correct the atrial defect
Anticoagulants and beta-blockers to control rate
Diuretics, total bed rest, and cardioversion if necessary
The initial medical management for a symptomatic patient with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which of the following medications?
Lisinopril, an ACE inhibitor
Lasix, a diuretic
Lanoxin, an inotropic
Propranolol, a beta-adrenergic blocker
The amount of blood pumped by one ventricle in one minute, is called the
ejection fraction.
stroke volume.
cardiac output.
end-diastolic volume.
If someone's heart has a stroke volume of 70 ml and a heart rate of 90 beat/minute, the cardiac output would be
0.77 L/min
6.3 L/min
1.28 ml/min
70 ml/min
Any mechanism that increases heart rate is said to have a positive ____ effect.
inotropic
feedback
chronotropic
cholinergic
Stroke volume is regulated by all of the following except
peripheral resistance
contractility
cardiac output
The preload acting on a ventricle is equivalent to that chamber's
stroke volume
end-diastolic volume
ejection fraction
The afterload imposed on a ventricle refers to
the amount of blood added to a ventricle by atrial systole
the ejection fraction, or percentage of EDV ejected by ventricular systole
Its end-systolic volume, the blood left after contraction is complete
the total peripheral resistance opposing the ejection of blood.
The Frank-Starling law of the heart describes the proportional relationship between
stroke volume and end-diastolic volume
the left and right ventricles
stroke volume and cardiac output
stroke volume is and total peripheral resistance
A positive inotropic agent is something that
increases the heart rate in positive feedback loop
decreases the contractility of myocardial fibers
increases the contractility of myocardial fibers
reduces the heart rate in positive feedback loop
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?
Dyspnoea and crackles in bilateral lung bases
Muscle cramping and cyanosis in the feet
Chest pain and intermittent ventricular tachycardia
Petechia and spontaneous bleeding
Which one of the following is not a pathophysiological change associated with heart failure?
Decreased angiotensin II production.
Increased myocardial oxygen demand.
Cardiac remodelling.
Decreased myocardial contractility.
A 3-year-old child with right-sided heart failure has been admitted for worsening of his condition. Which of the following assessments would be considered one of the earliest signs of systemic venous congestion in this toddler?
Breathlessness with activity
Increased urine output
Enlargement of the liver
Excessive crying
A nurse will be providing care for a female patient who has a 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
has cyanotic lips and extremities, low urine output, and low blood pressure.
complains of dyspnea and has adventitious breath sounds on auscultation (listening).
has a distended bladder, facial edema, and nighttime difficulty breathing.
has pitting edema to the ankles and feet bilaterally, decreased activity tolerance, and occasional upper right quadrant pain.
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?
Anticoagulant, antihypertensive, calcium supplement
Beta-blocker, potassium supplement, anticoagulant
Diuretic, ACE inhibitor, beta-blocker
Antihypertensive, diuretic, antiplatelet aggregator
Atrial fibrillation may:
Increase turbulence within the atrial chamber
Induce an irregular heart rate
increase the risk of thromboembolism
All answers are correct
By definition, tachycardia describes any heart rate exceeding ______ beats/min
60
75
95
100
Complete cessation of electrical signals from the AV node to the ventricles is known as:
first degree block
second degree block
Third degree block
all answers are correct
What changhe results from total heart block
Spontaneous slow ventricular contractions, not coordinated with atrial contraction
a wide QRS wabe
Periodic omission of a ventricular contraction
A prolonged PR interval
A 65-year-old male with history of untreated hypertension is now experiencing left heart failure. The most likely reason is
myocardial hypertrophy and ventricular remodelling
alterations in alpha and beta receptor function
Inhibition of renin and aldosterone
ventricular dilation and wall thinning
Excess preload can be reduced by
use of diuretics
Use of antidiuretics
increasing volume intake, that is, drinking more fluid
Which of the following would increase the work load of the left ventricle
stenosis of the aortic semilunar valves
regurgitating aortic semilunar valves
hypertension
Paroxysmal nocturnal dyspnea is marked by
haemoptysis and rales
cardiomegaly
Bradycardia and weak pulse
distended neck veins and flushed face
A very rapid heart rate reduces cardiac output because:
Ventricular fibrillation develops immediately
venous return is increased
conduction through the AV node is impaired
ventricular filling is reduced
Pericarditis causes a reduction in cardiac output as a result of which of the following
delays in the conduction system, interfering with a cardiac rhythm
Excess fluid in the pericardial cavity, which decreases ventricular filling
Incompetent valves, which allow regurgitation of blood
Weak myocardial contractions due to friction rub
A 63-year-old male client has been diagnosed with bundle branch block. how will this clients care team most likely expect his condition to be expressed diagnostically
his ECG will show an inordinately wide QRS complex because impulses are bypassing the normal conduction tissue
His AV node will be performing the primary pacemaker role due to inadequacy of the SA node
Conduction from the purkinje fibers to the bundle branches is compromised by inadequate conduction
His ECG will show a flattened P wave as a result of impaired atrial depolarization
Clients who have renal impairment are at risk of developing ________ during treatment with ACE inhibitors
Hyperkalaemia
Hypernatraemia
Hypokalaemia
Hyponatraemia
Right heart failure will likely cause:
Pitting oedema in the lower legs resulting from increased venous pressure
non-pitting oedema in the arms, resulting from decreased arterial pressure
pulmonary oedema from increased left ventricular filling
Which of the following drugs improves cardiac efficiency by slowing the heart rate and increasing the force of cardiac contractions?
Digoxin
epinephrine
furosemide
Nifedipine
Compensation mechanisms for decreased cardiac output in cases of congestive heart failure include:
increased renin and aldosterone secretions
Slow cardiac contractions
Fatigue and cold intolerance
Decreased erythropoietin secretion
A 72-year-old female has history of right heart failure caused by a right ventricular myocardial infarction. which of the following symptoms are directly related to her heart failure?
significant oedema to both lower legs and feet
Decreased urine output
pulmonary congestion
You are looking after a 61-year-old male who has presented with a new onset of atrial fibrilation. which of the following courses of treatment would you most likely expect the attending physician to initiate?
Intermediate cardioversion followed by surgery to correct the atrial defect
anticoagulants and beta-blockers to control rate
Anti hypertensives and constant cardiac monitoring in a high acuity unit
Calcium channel blockers and beta blockers to prolong QRS complex
A number of patients in an acute cardiac care unit of a hospital have diagnoses of impaired cardiac conduction. Which of the following patients is most deserving of immediate medical attention?
A 69-year-old who has entered ventricular fibrillation
a 60-year-old women who has just been diagnosed with a first degree AV block
A 60-Year-Old male with premature ventricular contractions (PVC) and a history of atrial fibrillation
A 46-year-old man whose ECG shows him to be in ventricular tachycardia
Pericarditis may be caused by (choose the most correct answer)
1. infection 2. autoimmune conditions 3. Injury 4. Malignant neoplasm
1, 2.
1,3, 4
1, 2, 3, 4
3, 4
Pericarditis causes a reduction in cardiac output as a result of the following?
Weak myocardial contractions due to friction rub.
Delays in the conduction system interfering with cardiac rhythm
incompetent valves,, which affect regurgitation of blood
A patient who is experiencing some angina associated with tachycardia has been placed on verapamil, a calcium channel blocker. Knowing the mechanism of action of this medication, you should assess the patient for which of the following adverse reactions.
Bradycardia
sudden asytole
increased cardiac output
ventricular tachycardia
Which of the following would you not expect to be administered to a patient suffering heart failure?
Beta-agonist
ACE inhibitor
digoxin
diuretic
All but one of the following are signs of congestive heart failure EXCEPT:
Polyuria
Muscle fatigue
oedema
cough
In which blood vessels will failure of the left ventricle caused increased hydrostatic pressure?
Pulmonary capillaries
Veins of the legs and feet
jugular veins
blood vessels of the liver and spleen
