NCLEX-RN Exam Pack Set 3 (75 Questions & Answers Updated 2022), Exams of Nursing

Download NCLEX-RN Exam Pack Set 3 (75 Questions & Answers Updated 2022) and more Exams Nursing in PDF only on Docsity! 1 o Option A: Assisting the patient to ambulate prevents incidences of fall and injury. o Option B: Reminding the patient not to look at his feet while walking maintains the client’s independence while keeping him safe. o Option D: Encouraging the patient to feed himself is an appropriate goal of maintaining independence. Correct Answer: C. The NA performs the patient’s complete bath and oral care. The nursing assistant should assist the patient with morning care as needed, but the goal is to keep this patient as independent and mobile as possible. NCLEX-RN Exam Pack Set 3 (75 Questions & Answers Updated 2022) 1. 1. Question A patient with Parkinson’s disease has a nursing diagnosis of Impaired Physical Mobility related to neuromuscular impairment. You observe a nursing assistant performing all of these actions. For which action must you intervene? o A. The NA assists the patient to ambulate to the bathroom and back to bed. o B. The NA reminds the patient not to look at his feet when he is walking. o C. The NA performs the patient’s complete bath and oral care. o D. The NA sets up the patient’s tray and encourages the patient to feed himself. 2 • 2. Question The nurse is preparing to discharge a patient with chronic low back pain. Which statement by the patient indicates that additional teaching is necessary? o A. “I will avoid exercise because the pain gets worse.” o B. “I will use heat or ice to help control the pain.” o C. “I will not wear high-heeled shoes at home or work.” o D. “I will purchase a firm mattress to replace my old one.” Correct Answer: A. “I will avoid exercise because the pain gets worse.” Exercises are used to strengthen the back, relieve pressure on compressed nerves and protect the back from re-injury. Doing exercises to strengthen the lower back can help alleviate and prevent lower back pain. It can also strengthen the core, leg, and arm muscles. According to researchers, exercise also increases blood flow to the lower back area, which may reduce stiffness and speed up the healing process. o Option B: Ice and heat application are appropriate interventions for back pain. Applying ice or a reusable gel pack constricts blood vessels and reduces swelling around the injury. This is particularly useful for conditions, like a sprained ankle, that cause significant swelling. Heat has the opposite effect, increasing blood flow to the area. This relaxes muscle fibers, which can help when the client experiences spasms or stiffness. o Option C: People with chronic back pain should avoid wearing high-heeled shoes at all times. The normal s- curve of the spine acts as a cushion or spring, reducing stress on the vertebrae. When wearing high heels, the shape of the spine is altered and the client doesn’t get that same shock absorption as she walks, which, over time, can lead to uneven wear on the cartilage discs, joints and ligaments of the back. 5 • 5. Question A patient with a spinal cord injury at level C3-4 is being cared for in the ED. What is the priority assessment? o A. Determine the level at which the patient has intact sensation. o B. Assess the level at which the patient has retained mobility. o C. Check blood pressure and pulse for signs of spinal shock. o D. Monitor respiratory effort and oxygen saturation level. Correct Answer: D. Monitor respiratory effort and oxygen saturation level. The first priority for the patient with an SCI is assessing respiratory patterns and ensuring an adequate airway. The patient with a high cervical injury is at risk for respiratory compromise because the spinal nerves (C3 – 5) innervate the phrenic nerve, which controls the diaphragm. o Option A: Determining this data can be done after addressing the concerns on the respiratory status of the patient. o Option B: This data can be assessed after monitoring the respiratory effort and oxygen saturation level of the patient. o Option C: Vital signs checking is also necessary, but not as high priority. Vital signs can be quite abnormal following SCI. In addition to the usual causes in trauma such as pain, bleeding, and distress, this can be due to loss of autonomic control, which occurs particularly in cervical or high thoracic injuries. The autonomic nervous system controls our HR, BP temperature, etc. Autonomic instability is most acute in the first few days to weeks of the injury. 6 o Option A: Assessing the patient’s respiratory status would require the knowledge of a registered nurse. o Option C: Monitoring patients requires additional education and is appropriate for the scope of practice for professional nurses. o Option D: The nursing assistant may assist with turning and repositioning the patient and may remind the patient to cough and deep breathe but does not teach the patient how to perform these actions. Correct Answer: B. Take the patient’s vital signs and record them every 4 hours. The nursing assistant’s training and education include taking and recording the patient’s vital signs. • 6. Question You are pulled from the ED to the neurologic floor. Which action should you delegate to the nursing assistant when providing nursing care for a patient with SCI? o A. Assess the patient's respiratory status every 4 hours. o B. Take the patient’s vital signs and record them every 4 hours. o C. Monitor nutritional status including calorie counts. o D. Have the patient turn, cough, and deep breathe every 3 hours. • 7. Question You are helping the patient with an SCI to establish a bladder- retraining program. What strategies may stimulate the patient to void? Select all that apply. o A. Stroke the patient’s inner thigh. o B. Pull on the patient’s pubic hair. o C. Initiate intermittent straight catheterization. o D. Pour warm water over the perineum. 7 o Option C: Intermittent bladder catheterization can be used to empty the patient’s bladder, but it will not stimulate voiding. Correct Answers: A, B, D, & E All of the strategies, except straight catheterization, may stimulate voiding in patients with SCI. o Option A: Checking for signs of pressure within the scope of practice of the LPN/LVN. o Option C: Observing for signs of an infection is within the scope of practice of the LPN/LVN. o Option D: The LPN/LVN also has the appropriate skills for cleaning the halo insertion sites with hydrogen peroxide. o Option B: Neurologic examination requires additional education and skill appropriate to the professional RN. Correct Answer: A, C, & D o E. Tap the bladder to stimulate detrusor muscle. • 8. Question The patient with a cervical SCI has been placed in fixed skeletal traction with a halo fixation device. When caring for this patient the nurse may delegate which action (s) to the LPN/LVN? Select all that apply. o A. Check the patient’s skin for pressure from the device. o B. Assess the patient’s neurologic status for changes. o C. Observe the halo insertion sites for signs of infection. o D. Clean the halo insertion sites with hydrogen peroxide. • 9. Question You are preparing a nursing care plan for the patient with SCI including the nursing diagnosis Impaired Physical Mobility and Self-Care Deficit. The patient tells you, “I don’t know why we’re 10 o A. Fatigue related to disease state o B. Activity Intolerance due to generalized weakness o C. Impaired Physical Mobility related to neuromuscular impairment o D. Self-care Deficit related to fatigue and neuromuscular weakness Correct Answer: D. Self-care Deficit related to fatigue and neuromuscular weakness At this time, based on the patient’s statement, the priority is Self- Care Deficit related to fatigue after physical therapy. Fatigue is described as an overwhelming feeling of lassitude or lack of physical or mental energy that interferes with activities. o Option A: The patient might be experiencing fatigue, but it might be due to the activities at physical therapy. Fatigue is one of the most common symptoms of MS, reported by at least 75% of patients with the disease. o Option B: Activity intolerance in a patient with MS is appropriate, but not related to the statement. An estimated 50–60% of persons with MS describe fatigue as one of their most bothersome symptoms, and it is a major reason for unemployment among MS patients. o Option C: Impaired physical mobility is appropriate to a patient with MS, but it is not related to the patient’s statement. Spasticity in MS is characterized by increased muscle tone and resistance to movement; it occurs most frequently in muscles that function to maintain an upright posture. The muscle stiffness greatly increases the energy expended to perform activities of daily living (ADLs), which in turn contributes to fatigue. • 12. Question The LPN/LVN, under your supervision, is providing nursing care for a patient with GBS. What observation would you instruct the LPN/LVN to report immediately? 11 o A. Complaints of numbness and tingling. o B. Facial weakness and difficulty speaking. o C. Rapid heart rate of 102 beats per minute. o D. Shallow respirations and decreased breath sounds. Correct Answer: D. Shallow respirations and decreased breath sounds The priority interventions for the patient with GBS are aimed at maintaining adequate respiratory function. These patients are at risk for respiratory failure, which is urgent. Upon presentation, 40% of patients have a respiratory or oropharyngeal weakness. Ventilatory failure with required respiratory support occurs in up to one-third of patients at some time during the course of their disease. o Option A: These findings should be reported to the nurse but it is not an urgent matter. The typical patient with Guillain-Barré syndrome (GBS), which in most cases will manifest as acute inflammatory demyelinating polyradiculoneuropathy (AIDP), presents 2-4 weeks following a relatively benign respiratory or gastrointestinal illness with complaints of finger dysesthesias and proximal muscle weakness of the lower extremities. o Option B: Facial weakness and difficulty of speaking are common signs of GBS and must be reported, but it is not a priority. The classic clinical picture of weakness is ascending and symmetrical in nature. The lower limbs are usually involved before the upper limbs. Proximal muscles may be involved earlier than the more distal ones. Trunk, bulbar, and respiratory muscles can be affected as well. o Option C: A rapid heart rate is important and should be reported to the nurse, but it is not life-threatening. Autonomic nervous system involvement with dysfunction in the sympathetic and parasympathetic systems can be observed in patients with GBS. 12 o Option A: The nurse would notify the physician before giving the suppository because there may be orders for cultures before giving acetaminophen. o Option C: This patient’s vital signs need to be re- checked sooner than 1 hour. o Option D: Rescheduling the physical therapy can be delegated to the unit clerk and is not urgent. Focus: Prioritization Correct Answer: B. Notify the physician immediately. The changes that the nursing assistant is reporting are characteristics of myasthenia crisis, which often follows some type of infection. The patient is at risk for inadequate respiratory function. In addition to notifying the physician, the nurse should carefully monitor the patient’s respiratory status. The patient may need intubation and mechanical ventilation. • 13. Question The nursing assistant reports to you, the RN, that the patient with myasthenia gravis (MG) has an elevated temperature (102.20 F), heart rate of 120/minute, rise in blood pressure (158/94), and was incontinent of urine and stool. What is your best first action at this time? o A. Administer an acetaminophen suppository o B. Notify the physician immediately o C. Recheck vital signs in 1 hour o D. Reschedule patient’s physical therapy session • 14. Question You are providing care for a patient with an acute hemorrhage stroke. The patient’s husband has been reading a lot about strokes and asks why his wife did not receive alteplase. What is your best response? o A. “Your wife was not admitted within the time frame that alteplase is usually given.” 15 o Option A: Breathing patterns are irrelevant to blood flow. It has been suggested that the diaphragm will preferentially steal blood flow from working locomotor muscles during increased activity (Bradley & Leith, 1978; Musch, 1993). In healthy adults, the cost of breathing is <5% of the total oxygen consumption at low-level exercise but approaches 15% during heavy exercise in young athletes or older fit subjects (Aaron et al. 1992; Dempsey & Johnson, 1992). Further, reflex vasoconstriction of the locomotor muscles is evident when a substantial respiratory load is applied sufficient to elicit diaphragm fatigue Correct Answer: B. During diastole Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to coronary arteries is supplied during diastole. • 17. Question When do coronary arteries primarily receive blood flow? o A. During inspiration o B. During diastole o C. During expiration o D. During systole The circumflex artery itself divides into smaller arterial systems. o Option B: The internal mammary artery supplies the mammary. The internal thoracic artery (ITA), previously commonly known as the internal mammary artery (a name still common among surgeons), is an artery that supplies the anterior chest wall and the breasts. o Option D: The right coronary artery supplies the inferior wall of the heart. The right coronary artery supplies blood to the right ventricle and then supplies the underside (inferior wall) and backside (posterior wall) of the left ventricle. 16 o Option A: Cancer accounts for approximately 20%. o Option C: Liver failure accounts for less than 10% of all deaths in the US. o Option D: Less than 10% of all deaths in the US can be attributed to renal failure. Correct Answer: B. Coronary artery disease Coronary artery disease accounts for over 50% of all deaths in the US. • 18. Question Which of the following illnesses is the leading cause of death in the US? o A. Cancer o B. Coronary artery disease o C. Liver failure o D. Renal failure • 19. Question Which of the following conditions most commonly results in CAD? o A. Atherosclerosis o B. DM o Option C: Expiration is not related to the blood flow. The pulmonary system is intimately linked with the cardiovascular system anatomically and hemodynamically and plays a significant role in exercise intolerance through a number of mechanisms (Olson et al. 2006a,b;). o Option D: There is a little portion of the blood that the coronary arteries receive during systole. During systole, intramuscular blood vessels are compressed and twisted by the contracting heart muscle and blood flow to the left ventricle is at its lowest. The force is greatest in the subendocardial layers where it approximates to intramyocardial pressure. 17 o C. MI o D. Renal failure Correct Answer: A. Atherosclerosis Atherosclerosis, or plaque formation, is the leading cause of CAD. o Option B: DM is a risk factor for CAD but isn’t the most common cause. Near-normal glycemic control for a median of 3.5 to 5 years does not reduce cardiovascular events. Thus, the general goal of HbA1c <7% appears reasonable for the majority of patients. Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes and is an independent cause of excess morbidity and mortality. o Option D: Renal failure doesn’t cause CAD, but the two conditions are related. Chronic kidney disease (CKD) accelerates the course of coronary artery disease, independent of conventional cardiac risk factors. In addition, CKD has been shown to confer inferior clinical outcomes following successful coronary revascularisation, which may be offset by arterial grafting. o Option C: Myocardial infarction is commonly a result of CAD. Myocardial infarction occurs when a coronary artery is so severely blocked that there is a significant reduction or break in the blood supply, causing damage or death to a portion of the myocardium (heart muscle). • 20. Question Atherosclerosis impedes coronary blood flow by which of the following mechanisms? o A. Plaques obstruct the vein o B. Plaques obstruct the artery o C. Blood clots form outside the vessel wall o D. Hardened vessels dilate to allow the blood to flow through 20 Correct Answer: B. Enhance myocardial oxygenation Enhancing myocardial oxygenation is always the first priority when a client exhibits signs and symptoms of cardiac Cholesterol levels above 200 mg/dl are considered excessive. They require dietary restriction and perhaps medication. Exercise also helps reduce cholesterol levels. The other levels listed are all below the nationally accepted levels for cholesterol and carry a lesser risk for CAD. The normal level of serum cholesterol is within 125 to 200 mg/dl. o Option A: 100mg/dl is an acceptable level of serum cholesterol. An elevated low-density lipoprotein cholesterol (LDL-C) level is a major risk factor for CAD, and several large, randomized, primary prevention trials have shown that lowering LDL-C levels with statins reduces the risk of major coronary events and coronary death. o Option B: 150 mg/dl is within the normal level of serum cholesterol. LDL is the particle that is responsible for transporting cholesterol to tissues. Cholesterol transportation is achieved by binding of the LDL receptor and apoB. o Option C: 175 mg/dl is still an acceptable level of serum cholesterol. HDL is a molecule that is antioxidant, antiinflammatory, antiapoptotic, and increases macrophage cholesterol excretion and endothelial healing. The removal of cholesterol from the body by the liver via HDL is called reverse cholesterol transport. • 23. Question Which of the following actions is the first priority care for a client exhibiting signs and symptoms of coronary artery disease? o A. Decrease anxiety o B. Enhance myocardial oxygenation o C. Administer sublingual nitroglycerin o D. Educate the client about his symptoms 21 Correct Answer: C. Oral medication administration Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Nitroglycerin is the most compromise. Without adequate oxygen, the myocardium suffers damage. o Option A: Decreasing the client’s anxiety is also important, but it is not the priority. When someone is anxious, their body reacts in ways that can put an extra strain on their heart. The physical symptoms of anxiety can be especially damaging among individuals with existing cardiac disease. o Option C: Sublingual nitroglycerin is administered to treat acute angina, but its administration isn’t the first priority. Although nitroglycerin has a vasodilatory effect in both arteries and veins, the profound desired effects caused by nitroglycerin are primarily due to venodilation. Venodilation causes pooling of blood within the venous system, reducing preload to the heart, which causes a decrease in cardiac work, reducing anginal symptoms secondary to demand ischemia. o Option D: Although educating the client is important in care delivery, it is not a priority when a client is compromised. Patient education promotes patient- centered care and increases adherence to medication and treatments. An increase in compliance leads to a more efficient and cost-effective healthcare delivery system. Educating patients ensures continuity of care and reduces complications related to the illness. • 24. Question Medical treatment of coronary artery disease includes which of the following procedures? o A. Cardiac catheterization o B. Coronary artery bypass surgery o C. Oral medication administration o D. Percutaneous transluminal coronary angioplasty 22 Correct Answer: C. Inferior common vasodilator used for acute cases of angina. It works to dilate or widen the coronary arteries, increasing blood flow to the heart muscle and to relax the veins, lessening the amount of blood that returns to the heart from the body. This combination of effects decreases the amount of work for the heart. o Option A: Cardiac catheterization isn’t a treatment but a diagnostic tool. Cardiac catheterization (cardiac cath or heart cath) is a procedure to examine how well the heart is working. A thin, hollow tube called a catheter is inserted into a large blood vessel that leads to the heart. o Option B: Coronary artery bypass surgery is an invasive procedure. Coronary artery bypass grafting (CABG) is a procedure to improve poor blood flow to the heart. It may be needed when the arteries supplying blood to heart tissue, called coronary arteries, are narrowed or blocked. This surgery may lower the risk of serious complications for people who have obstructive coronary artery disease, a type of ischemic heart disease. CABG may also be used in an emergency, such as a severe heart attack. o Option D: Percutaneous transluminal coronary angioplasty is an invasive, surgical treatment. Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. • 25. Question Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart? o A. Anterior o B. Apical o C. Inferior o D. Lateral 25 Correct Answer: B. Left fifth intercostal space, midclavicular line The correct landmark for obtaining an apical pulse is the left intercostal space in the midclavicular line. This is the point of maximum impulse and the location of the left ventricular apex. o Option A: Normally, heart sounds aren’t heard in the midaxillary line. During systolic contraction of the heart, a high amplitude wave of blood gets ejected through the aortic valve out towards the periphery. This high-pressure wave distends the arteries, especially compliant “elastic” or “conducting” arteries, which tend to be larger and closer to the heart. The subsequent release of that distention somewhat sustains the systolic wave of blood throughout the body, creating a spike followed by a downward sloping plateau in pulse waveform. o Option C: The left second intercostal space in the midclavicular line is where the pulmonic sounds are auscultated. The intensity of the pulse is determined by blood pressure as well as other physiological factors such as ambient temperature. For example, colder temperatures cause vasoconstriction leading to decreased intensity. Besides the normal variation in a rhythm that occurs with the respiratory cycle, the heart rate should be regular in the absence of pathology. o Option D: Heart sounds are not heard in the seventh intercostal space in the midclavicular line. Pulses are accurately measured when the clinician places their fingertips onto the skin overlying the vessel (locations, see below) and focuses on different aspects of the pulse. (NB: although one often hears that utilization of the thumb for measuring pulses is less accurate secondary to increased perception of the clinician’s own pulsation during palpation, the author could not find data to support or refute this claim). If possible, the limb under evaluation should have support throughout palpation. 26 • 28. Question Which of the following systems is the most likely origin of pain the client describes as knifelike chest pain that increases in intensity with inspiration? o A. Cardiac o B. Gastrointestinal o C. Musculoskeletal o D. Pulmonary Correct Answer: D. Pulmonary Pulmonary pain is generally described by these symptoms. Pain may originate from several different structures within the chest, including the skin, ribs, intercostal muscles, pleura, esophagus, heart, aorta, diaphragm, or thoracic vertebrae. The pain may be transmitted by intercostal, sympathetic, vagus, and phrenic nerves. The innervations of the deep structures of the thorax follow common pathways to the central nervous system, making it difficult to localize the source of pain. o Option A: In cardiac pain, respirations are usually unaffected. Various schemes have been used to classify the etiologies of chest pain, but the most useful is to distinguish between acute and chronic patterns of pain. Patients with acute pain include those whose episodes are of recent onset or those who have had a recent increase in the intensity or frequency of recurrent pain. Patients with chronic pain include those who have recurrent episodes of pain occurring in a relatively stable pattern. o Option B: GI pains don’t change with respiration. The findings suggest that pain influences respiration by increasing its flow, frequency, and volume. Furthermore, paced slow breathing is associated with pain reduction in some of the studies, but evidence elucidating the underlying physiological mechanisms of this effect is lacking. o Option C: Musculoskeletal pain only increases with movement. The SNS is concerned with the regulation 27 • 29. Question A murmur is heard at the second left intercostal space along the left sternal border. Which valve area is this? o A. Aortic o B. Mitral o C. Pulmonic o D. Tricuspid Correct Answer: C. Pulmonic Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border. Murmurs of the cardiac system develop due to alterations in blood flow or mechanical operation. Murmurs develop from a multitude of mechanisms. Typical cases include low blood viscosity from anemia, septal defects, failure of the ductus arteriosus to close in newborns, excessive hydrostatic pressure on cardiac valves causing valve failure, hypertrophic obstructive cardiomyopathy, and valvular specific pathologies. o Option A: Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Aortic regurgitation, also known as aortic insufficiency, is a decrescendo blowing diastolic murmur heard best at the left lower sternal border, heard when blood flows retrograde into the left ventricle. This is most commonly seen in aortic root dilation and as sequelae of aortic stenosis. o Option B: Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Mitral stenosis is a diastolic murmur, best heard at the left 5th midclavicular line. It is associated with infective endocarditis and chronic rheumatic heart disease. Mitral regurgitation is a systolic murmur, best heard at of vascular tone, blood flow, and blood pressure, as sympathetic nerves have stimulating effects on the heart (improving circulation) and respiratory system (increasing oxygen intake). Pain, therefore, increases heart rate, blood pressure, and respiratory rate. 30 Correct Answer: C. Coronary artery thrombosis Coronary artery thrombosis causes occlusion of the artery, leading to myocardial death. Myocardial infarction occurs when a coronary artery is so severely blocked that there is a significant reduction or break in the blood supply, causing damage or death to a portion of the myocardium (heart muscle). o Option A: An aneurysm is an outpouching of a vessel and doesn’t cause an MI. On exertion, elevated blood pressure could cause expansion of the aneurysmal cavity, aggravating the coronary ischemia, and • 32. Question Which of the following conditions is most commonly responsible for myocardial infarction? o A. Aneurysm o B. Heart failure o C. Coronary artery thrombosis o D. Renal failure o Option A: Morphine can also cause sedation on the client, but it is not the main purpose of administering it. Morphine is rarely used for procedural sedation. However, for small procedures, physicians will sometimes combine a low dose of morphine with a low dose of benzodiazepine-like lorazepam. o Option B: Pain is decreased when morphine is given, but it is not the primary reason for administration. FDA-approved usage of morphine sulfate includes moderate to severe pain that may be acute or chronic. Most commonly used in pain management, morphine provides significant relief to patients afflicted with pain. o Option C: Morphine will also decrease anxiety, but isn’t primarily given for this reason. Morphine can decrease the heart rate, blood pressure, and venous return. Morphine can also stimulate local histamine- mediated processes. 31 Correct Answer: C. Potassium Supplemental potassium is given with furosemide because of the potassium loss that occurs as a result of this diuretic. Loop diuretics act at the ascending loop of Henle in the kidney and help the body push out extra fluid that could accumulate in the lungs or legs and ankles when the heart is unable to completely pump blood throughout the body. But they may also cause the body to eliminate excessive amounts of potassium, which might be expected to increase mortality from heart arrhythmias. As a precaution, therefore, many doctors prescribe potassium supplements to their patients receiving loop diuretics. • 33. Question What supplemental medication is most frequently ordered in conjunction with furosemide (Lasix)? o A. Chloride o B. Digoxin o C. Potassium o D. Sodium eventually would have produced myocardial infarction. However, this only occurs in very rare cases. o Option D: Renal failure can be associated with MI but isn’t a direct cause. All-cause mortality of dialysis patients with acute myocardial infarction (AMI) is 59% at 1 year and about 73% at 2 years. AMI in patients with nondialysis-dependent advanced CKD is also associated with poor long-term cardiovascular outcomes and survival. o Option B: Heart failure is usually the result of an MI. It produces both a vasculopathy and left ventricular dysfunction and fibrosis. It produces both a vasculopathy and left ventricular dysfunction and fibrosis. Endothelial dysfunction in the coronary arteries can lead to acute coronary events. Left ventricular dysfunction will cause the progression of heart failure, and left ventricular fibrosis and dysfunction provide an arrhythmic substrate. 32 Correct Answer: D. Metabolic Both glucose and fatty acids are metabolites whose levels increase after myocardial infarction. Acute myocardial infarction evokes a characteristic neurohumoral response: Catecholamine release is increased, plasma contents of free fatty acids and glucose are elevated and glucose tolerance is diminished. o Option A: Mechanical changes are those that affect the pumping action of the heart. The main mechanical • 34. Question After myocardial infarction, serum glucose levels and free fatty acids are both increased. What type of physiologic changes are these? o A. Electrophysiologic o B. Hematologic o C. Mechanical o D. Metabolic o Option A: Chloride isn’t lost during diuresis. Continued use of diuretics, will cause some overall sodium and chloride loss. The body, however, has a natural way of compensating for these losses by reducing the excretion of sodium and chloride and stabilizing the amount of sodium, chloride, and water in the body. In this manner, fluid depletion usually is prevented. o Option B: Digoxin acts to increase contractility but isn’t given routinely with furosemide. People with heart failure who take digoxin are commonly given medicines called diuretics. These drugs remove excess fluid from the body. Many diuretics can cause potassium loss. A low level of potassium in the body can increase the risk of digitalis toxicity. o Option D: Sodium is not lost during diuresis. Diuretic drugs increase urine output by the kidney (i.e., promote diuresis). This is accomplished by altering how the kidney handles sodium. If the kidney excretes more sodium, then water excretion will also increase. 35 o Option A: Cardiac catheterization is an invasive study for determining coronary artery disease and may also indicate the location of myocardial damage, but the study may not be performed immediately. o Option B: Cardiac enzymes are used to diagnose MI but can’t determine the location. o Option C: An echocardiogram is used most widely to view myocardial wall function after an MI has been diagnosed. Correct Answer: D. Electrocardiogram The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. • 37. Question Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage? o A. Cardiac catheterization o B. Cardiac enzymes o C. Echocardiogram o D. Electrocardiogram • 38. Question What is the first intervention for a client experiencing myocardial infarction? pulmonary valve. This valve helps control the flow of blood passing from the right ventricle to the lungs. A leaky pulmonary valve allows blood to flow back into the heart chamber before it gets to the lungs for oxygen. o Option C: Right-sided heart failure can be caused by a pulmonic valve or tricuspid valve malfunction. This is the narrowing of the pulmonic valve that limits blood flow out of the right ventricle. o Option D: Tricuspid valve malfunction causes right- sided heart failure. The tricuspid valve doesn’t close properly. This causes blood in the right ventricle to flow back into the right atrium. 36 o A. Administer morphine o B. Administer oxygen o C. Administer sublingual nitroglycerin o D. Obtain an electrocardiogram Correct Answer: B. Administer oxygen Administering supplemental oxygen to the client is the first priority of care. The myocardium is deprived of oxygen during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage. o Option A: Morphine may be given after administering supplemental oxygen first. As a potent opioid, morphine has seemed to be the ideal analgesic. It has innate hemodynamic effects that are beneficial during MI. It decreases heart rate, blood pressure, and venous return, and it may also stimulate local histamine-mediated processes. Theoretically, this reduces myocardial oxygen demand. o Option C: Sublingual nitroglycerin is also used to treat MI, but they’re more commonly administered after the oxygen. Nitroglycerin remains the first-line treatment for angina pectoris and acute myocardial infarction. Nitroglycerin achieves its benefit by giving rise to nitric oxide, which causes vasodilation and increases blood flow to the myocardium. o Option D: An ECG is the most common diagnostic tool used to evaluate MI. In a myocardial infarction transmural ischemia develops. In the first hours and days after the onset of myocardial infarction, several changes can be observed on the ECG. First, large peaked T waves (or hyperacute T waves), then ST elevation, then negative T waves, and finally pathologic Q waves develop. • 39. Question What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying? 37 o Option B: Option B may give the client false hope. o Option C: Telling the client that he will feel better soon would give him false hope. o Option D: No one can determine if a client experiencing MI will feel or get better and therefore, these responses are inappropriate. Correct Answer: A. “Tell me about your feelings right now.” Validation of the client’s feelings is the most appropriate response. It gives the client a feeling of comfort and safety. Correct Answer: A. Beta-adrenergic blockers Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. o Option B: Calcium channel blockers reduce the workload of the heart by decreasing the heart rate. o A. “Tell me about your feelings right now.” o B. “When the doctor arrives, everything will be fine.” o C. “This is a bad situation, but you’ll feel better soon.” o D. “Please be assured we’re doing everything we can to make you feel better.” • 40. Question Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? o A. Beta-adrenergic blockers o B. Calcium channel blockers o C. Narcotics o D. Nitrates 40 o Option B: Blood pressure is usually only affected if the heart rate is too low, in which case the nurse would withhold digoxin. o Option C: The radial pulse can be affected by cardiac and vascular disease and therefore, won’t always accurately depict the heart rate. o Option D: Digoxin has no effect on respiratory function. Digoxin is used to treat heart failure, usually along with other medications. It is also used to treat a certain type of irregular heartbeat (chronic atrial fibrillation). Correct Answer: A. Apical pulse An apical pulse is essential for accurately assessing the client’s heart rate before administering digoxin. The apical pulse is the most accurate point in the body. • 44. Question Which of the following parameters should be checked before administering digoxin? o A. Apical pulse o B. Blood pressure o C. Radial pulse o D. Respiratory rate • 45. Question Toxicity from which of the following medications may cause a client to see a green halo around lights? o Option A: In high-Fowler’s position, the veins would be barely discernible above the clavicle. o Option B: Inclined pressure can’t be seen when the head of the bed is raised 10 degrees because the point that marks the pressure level is above the jaw (therefore, not visible). o Option D: Inclined pressure cannot be seen when the client is in a supine position because the point that marks the pressure level is above the jaw. 41 o A. Digoxin o B. Furosemide o C. Metoprolol o D. Enalapril Correct Answer: A. Digoxin One of the most common signs of digoxin toxicity is the visual disturbance known as the green halo sign. o Option B: Furosemide does not cause this kind of toxicity. The principal signs and symptoms of overdose with furosemide are dehydration, blood volume reduction, hypotension, electrolyte imbalance, hypokalemia, and hypochloremic alkalosis, and are extensions of its diuretic action. o Option C: Metoprolol is not associated with this effect. Poisoning due to an overdose of metoprolol may lead to severe hypotension, sinus bradycardia, atrioventricular block, heart failure, cardiogenic shock, cardiac arrest, bronchospasm, impairment of consciousness, coma, nausea, vomiting, cyanosis, hypoglycemia, and, occasionally, hyperkalemia. o Option D: This medication isn’t associated with such an effect. While there is limited data about enalapril overdose in humans, overdosage may result in marked hypotension and stupor based on the pharmacological properties of the drug. The most common adverse effects of enalapril include cough, hypotension, stupor, headache, dizziness, and fatigue. • 46. Question Which of the following symptoms is most commonly associated with left-sided heart failure? o A. Crackles o B. Arrhythmias o C. Hepatic engorgement 42 o D. Hypotension Correct Answer: A. Crackles Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. The left ventricle of the heart no longer pumps enough blood around the body. As a result, blood builds up in the pulmonary veins (the blood vessels that carry blood away from the lungs). This causes shortness of breath, trouble breathing or coughing – especially during physical activity. Left-sided heart failure is the most common type. o Option B: Arrhythmias can be associated with both right and left-sided heart failure. Cardiac arrhythmia is an abnormal rate and/or rhythm of a heart due to its abnormal electrical impulse origination and/or propagation. Various etiologies can cause arrhythmias. Heart failure (HF) is a clinical syndrome due to an impaired heart that can not pump sufficient blood to meet the systemic metabolic needs. o Option C: Hepatomegaly is prominent with chronic right-sided heart failure. The primary pathophysiology involved in hepatic dysfunction from HF is either passive congestion from increased filling pressures or low cardiac output and the consequences of impaired perfusion. Passive hepatic congestion due to increased central venous pressure may cause elevations of liver enzymes and both direct and indirect serum bilirubin. o Option D: Left-sided heart failure causes hypertension secondary to an increased workload on the system. Hypertension increases the workload on the heart inducing structural and functional changes in the myocardium. These changes include hypertrophy of the left ventricle, which can progress to heart failure. • 47. Question In which of the following disorders would the nurse expect to assess sacral edema in bedridden client? o A. DM 45 o Option A: The parasympathetic nervous system is responsible for decreasing the heart rate. M1 receptors are the inhibitory receptors. They are present in the heart especially on the SA node and AV node. Activation of M1 receptors decreases heart rate. It does not have any effect on the force of contraction. o Option C: Hypotension is caused by the parasympathetic nervous system. The baroreceptor reflex stimulates the parasympathetic system. The PSNS causes relaxation of blood vessels, decreasing Correct Answer: B. Tachycardia Stimulation of the sympathetic nervous system causes tachycardia and increased contractility. Norepinephrine released from neurons via the right stellate ganglion increases heart rate and shortens atrioventricular conduction via the sinus and atrioventricular nodes. • 50. Question Stimulation of the sympathetic nervous system produces which of the following responses? o A. Bradycardia o B. Tachycardia o C. Hypotension o D. Decreased myocardial contractility o Option A: Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. They cause the heart to beat more slowly and with less force, which lowers blood pressure. o Option B: Calcium channel blockers decrease the heart rate and ultimately decrease the workload of the heart. o Option C: Diuretics are administered to decrease the overall vascular volume, also decreasing the workload of the heart. Inotropic agents are administered to increase the force of the heart’s contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output. 46 • 51. Question Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output? o A. Angina pectoris o B. Cardiomyopathy o C. Left-sided heart failure o D. Right-sided heart failure Correct Answer: D. Right-sided heart failure Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided heart failure. Here the right ventricle of the heart is too weak to pump enough blood to the lungs. This causes blood to build up in the veins (the blood vessels that carry blood from the organs and tissue back to the heart). The increased pressure inside the veins can push fluid out of the veins into the surrounding tissue. This leads to a build-up of fluid in the legs, or less commonly in the genital area, organs or the abdomen (belly). o Option A: Angina pectoris doesn’t cause weight gain, nausea, or a decrease in urine output. Angina is chest pain or discomfort caused when the heart muscle doesn’t get enough oxygen-rich blood. It may feel like pressure or squeezing in the chest. The discomfort also can occur in the shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. o Option B: Cardiomyopathy is usually identified as a symptom of left-sided heart failure. The left ventricle of the heart no longer pumps enough blood around the body. As a result, blood builds up in the pulmonary veins (the blood vessels that carry blood away from the lungs). This causes shortness of breath, trouble breathing, or coughing – especially during physical total peripheral resistance. It also decreases heart rate. As a result, blood pressure decreases. o Option D: Decreased myocardial contractility is related to the parasympathetic nervous system, which is responsible for slowing the heart rate. 47 • 52. Question What is the most common cause of an abdominal aortic aneurysm? o A. Atherosclerosis o B. DM o C. HPN o D. Syphilis Correct Answer: A. Atherosclerosis Atherosclerosis accounts for 75% of all abdominal aortic aneurysms. Plaques build up on the wall of the vessel and weaken it, causing an aneurysm. AAA is thought to be a degenerative process of the aorta, the cause of which remains unclear. It is often attributed to atherosclerosis because these changes are observed in the aneurysm at the time of surgery. o Option B: Diabetes mellitus does not directly cause an abdominal aortic aneurysm. Patients at greatest risk for AAA are men who are older than 65 years and have peripheral atherosclerotic vascular disease. A history of smoking often is elicited. o Option C: Hypertension accounts for 1-15% of cases of an abdominal aneurysm. A Swedish study showed that instances of AAA in elderly men have been decreasing, A phenomenon that can be attributed to a nationwide decline in smoking for the past 30 years, as well as the significantly improved longevity of the elderly population. o Option D: Syphilis is not related to AAA. Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on activity. Left-sided heart failure is the most common type. o Option C: Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Left- sided heart failure is usually caused by coronary artery disease (CAD), a heart attack, or long-term high blood pressure. 50 Correct Answer: D. Lower back pain Lower back pain results from the expansion of an aneurysm. The expansion applies pressure in the abdominal cavity, and the pain is referred to the lower back. o Option A: Abdominal pain is the most common symptom resulting from impaired circulation. The most typical manifestation of rupture is abdominal or back • 56. Question Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic aneurysm? o A. Abdominal pain o B. Absent pedal pulses o C. Angina o D. Lower back pain o Option B: Diaphoresis isn’t associated with an abdominal aortic aneurysm. At times, AAAs may cause symptoms from local compression, including early satiety, nausea, vomiting, urinary symptoms, or venous thrombosis from venous compression. o Option C: Headache is not a sign of an abdominal aortic aneurysm. Other symptoms include abdominal pain, groin pain, embolic phenomena affecting the toes (eg, livedo reticularis, or blue toe syndrome; see the image below), and fever. Occasionally, small AAAs thrombose, producing acute claudication. o Option D: Lower back pain, not upper, is a common symptom, usually signifying expansion and impending rupture of the aneurysm. Back pain can be caused by erosion of the AAA into adjacent vertebrae. abdominal, or groin pain for some time before rupture. Isolated groin pain is a particularly insidious presentation. This occurs with retroperitoneal expansion and pressure on either the right or left femoral nerve. This symptom may be present without any other associated findings, and a high index of suspicion is necessary to make the diagnosis. 51 o Option A: An abdominal aneurysm would only be visible on an X-ray if it were calcified. Plain radiography is often performed on patients with abdominal complaints before the diagnosis of AAA has been entertained. Using this method to evaluate patients with AAA is difficult because the only marginally specific finding, aortic wall calcification, is seen less than half of the time. Aortic-wall calcification (see the images below) may appear without aneurysm rim calcification, resulting in a high false-negative rate. o Option C: CT scan doesn’t give a direct view of the vessels. CT permits visualization of the retroperitoneum, is not limited by obesity or bowel gas, detects leakage, and allows concomitant evaluation of the kidneys. o Option D: Ultrasound doesn’t yield as accurate a diagnosis as the arteriogram. Ultrasonography is the Correct Answer: B. Arteriogram An arteriogram accurately and directly depicts the vasculature; therefore, it clearly delineates the vessels and any abnormalities. • 57. Question What is the definitive test used to diagnose an abdominal aortic aneurysm? o A. Abdominal X-ray o B. Arteriogram o C. CT scan o D. Ultrasound pain with a pulsatile abdominal mass. However, the symptoms may be vague, and the abdominal mass may be missed. o Option B: Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease. o Option C: Angina is associated with atherosclerosis of the coronary arteries. 52 • 58. Question Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client? o A. HPN o B. Aneurysm rupture o C. Cardiac arrhythmias o D. Diminished pedal pulses Correct Answer: B. Aneurysm rupture Rupture of an aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this type of client. The layers of the aortic wall can also separate (aortic dissection). This produces severe, tearing pain in the chest, back or abdomen. The potential for rupture is the most serious risk associated with an aortic aneurysm. A ruptured aortic aneurysm can cause life-threatening internal bleeding and/or a stroke. o Option A: Hypertension should be avoided and controlled because it can cause the weakened vessel to rupture. Hypertension has been considered a potential risk factor for AAA; but the findings from prospective cohort studies have not been entirely consistent, nor have they been summarised in a comprehensive meta-analysis. o Option D: Diminished pedal pulses, a sign of poor circulation to the lower extremities, are associated with an aneurysm but aren’t life-threatening. The appearance of microembolic lower limb infarcts in a patient with easily palpable pedal pulses may suggest the presence of either popliteal or abdominal aneurysms. o Option C: Cardiac arrhythmias aren’t directly linked to an aneurysm. Ventricular aneurysms may cause standard imaging tool for AAA. When performed by trained personnel, it has a sensitivity of nearly 100% and a specificity approaching 96% for the detection of infrarenal AAA. 55 o D. Syphilis Correct Answer: B. HPN Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur. The association between hypertension and AAA could potentially be confounded by other risk factors because hypertension is more common among persons with overweight and obesity, less physical activity, who smoke and who have unhealthy diets. o Option A: Diabetes mellitus doesn’t have a direct link to an aneurysm. Diabetes mellitus (DM) is a strong cardiovascular risk factor; however, multiple epidemiological studies have confirmed that a negative relationship exists between DM and abdominal aortic aneurysm (AAA) presence, growth, and rupture. Arteries from patients with DM are often harder and more calcified than those from patients without DM; however, increased vessel wall calcification alone does not appear to explain the reduced rate of aortic expansion seen in diabetic patients. o Option C: Atherosclerotic changes can occur with peripheral vascular diseases and are linked to aneurysms, but the link isn’t as strong as it is with hypertension. o Option D: Only 1% of clients with syphilis experience an aneurysm. Classically, syphilitic aneurysms occur in 90% of cases on the thoracic aorta, and in 10% in the abdominal aorta [3, 7–9]. Infection of the aortic wall develops during the secondary or bacteremic phase of syphilis, having a latent period from infection until the clinical presentation ranging from 5 to 50 years. • 62. Question Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client? o A. Bruit 56 o B. Crackles o C. Dullness o D. Friction rubs Correct Answer: A. Bruit A bruit, a vascular sound resembling a heart murmur, suggests partial arterial occlusion. In addition to abdominal palpation, auscultation for abdominal or femoral bruits may be useful for clinical detection of AAA. Auscultation is performed along the course of the aortic and femoral arteries. However, absence of a bruit does not exclude an aneurysm. o Option B: Crackles are indicative of fluid in the lungs. Crackles occur if the small air sacs in the lungs fill with fluid and there’s any air movement in the sacs, such as when breathing. The air sacs fill with fluid when a person has pneumonia or heart failure. o Option C: Dullness is heard over solid organs, such as the liver. A dull or thud-like sound is normally heard over dense areas such as the heart or liver. Dullness replaces resonance when fluid or solid tissue replaces air-containing lung tissues, such as occurs with pneumonia, pleural effusions, or tumors o Option D: Friction rubs indicate inflammation of the peritoneal surface. A pericardial friction rub is pathognomonic for acute pericarditis; the rub has a scratching, grating sound similar to leather rubbing against leather. Serial examinations may be necessary for detection, as a friction rub may be transient from one hour to the next and is present in approximately 50% of cases. • 63. Question Which of the following groups of symptoms indicated a ruptured abdominal aneurysm? o A. Lower back pain, increased BP, decreased RBC, increased WBC 57 Correct Answer: B. Severe lower back pain, decreased BP, decreased RBC, increased WBC Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal cavity. When a rupture occurs, the pain is constant because it can’t be alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so blood pressure wouldn’t increase. For the same reason, the RBC count has decreased – not increased. The WBC count increases as cells migrate to the site of injury. o Option A: The pain felt during rupture is severe. Due to the loss of blood, the blood pressure decreases. o Option C: The WBC count increases because the cells migrate to the site of injury. o Option D: The pain is not intermittent during an aneurysm; it is constant and severe. o B. Severe lower back pain, decreased BP, decreased RBC, increased WBC o C. Severe lower back pain, decreased BP, decreased RBC, decreased WBC o D. Intermittent lower back pain, decreased BP, decreased RBC, increased WBC • 64. Question Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the perineal area? o A. Hernia o B. Stage 1 pressure ulcer o C. Retroperitoneal rupture at the repair site o D. Rapid expansion of the aneurysm 60 o D. Surgical intervention Correct Answer: D. Surgical intervention When the vessel ruptures, surgery is the only intervention that can repair it. The techniques used for aneurysm surgery have for long been standardized. 95% of aneurysms are accessible via a small frontotemporal craniotomy centred over the pterion. Only occasional cases, principally aneurysms of the distal anterior cerebral artery and the lower vertebrobasilar trunk, require different surgical approaches. o Option A: Administration of antihypertensive medications can help control hypertension, reducing the risk of rupture. Normalization of blood pressure by hydralazine significantly reduced the incidence of ruptured aneurysms and the rupture rate. There was a dose-dependent relationship between the reduction of blood pressure and the prevention of aneurysmal rupture. Captopril and losartan were able to reduce the rupture rates without affecting systemic hypertension induced by DOCA-salt treatment. o Option B: An aortogram is a diagnostic tool used to detect an aneurysm. An aortogram is an invasive diagnostic test using a catheter to inject dye (contrast medium) into the aorta. X-rays are taken of the dye as it travels within the aorta, allowing clear visualization of blood flow. This way, any structural abnormalities of the aorta will be accurately seen. o Option C: Beta-blockers can slow the heartbeat, thereby decreasing blood pressure. Antihypertensives are used to reduce the rate of rise of the aortic pressure (dP/dt). For acute reduction of arterial pressure, the potent vasodilator sodium nitroprusside is very effective. To reduce dP/dt acutely, administer a beta-blocker intravenously (IV) in incremental doses until a heart rate of 60-80 beats/min is attained. When beta-blockers are contraindicated, as in second- or third-degree atrioventricular block, consider using calcium-channel blockers. 61 o Option B: Coronary artery disease is directly related to atherosclerosis. Coronary artery disease is caused by plaque buildup in the wall of the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time. This process is called atherosclerosis. o Option C: During the progression of atherosclerosis, myeloid cells destabilize lipid-rich plaque in the arterial wall and cause its rupture, thus triggering myocardial infarction. o Option D: Pericardial effusion is the escape of fluid into the pericardial sac, a condition associated with pericarditis and advanced heart failure. Correct Answer: A. Cardiomyopathy Cardiomyopathy isn’t usually related to underlying heart disease such as atherosclerosis. The etiology in most cases is unknown. • 67. Question Which of the following heart muscle diseases is unrelated to other cardiovascular diseases? o A. Cardiomyopathy o B. Coronary artery disease o C. Myocardial infarction o D. Pericardial Effusion • 68. Question Which of the following types of cardiomyopathy can be associated with childbirth? o A. Dilated o B. Hypertrophic o C. Myocarditis o D. Restrictive 62 Correct Answer: C. Hypertrophic In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum – not the ventricle chambers – is apparent. Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disease. It is Correct Answer: A. Dilated Although the cause isn’t entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy of the first few months after birth. The condition may result from a pre-existing cardiomyopathy not apparent prior to pregnancy. o Option B: Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency. o Option C: Myocarditis isn’t specifically associated with childbirth. Myocarditis is an inflammation of the heart muscle (myocardium). Myocarditis can affect the heart muscle and the heart’s electrical system, reducing the heart’s ability to pump and causing rapid or abnormal heart rhythms (arrhythmias). o Option D: Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial. Restrictive cardiomyopathy (RCM) is a rare disease of the myocardium and is the least common of the three clinically recognized and described cardiomyopathies. It is characterized by diastolic dysfunction with restrictive ventricular physiology, whereas systolic function often remains normal. Atrial enlargement occurs due to impaired ventricular filling during diastole, but the volume and wall thickness of the ventricles are usually normal. • 69. Question Septal involvement occurs in which type of cardiomyopathy? o A. Congestive o B. Dilated o C. Hypertrophic o D. Restrictive 65 Contractile dysfunction and abnormal myocardial remodeling can lead to hypertrophic cardiomyopathy or dilated cardiomyopathy. Mechanical stretching, circulating neurohormones, and oxidative stress are significant stimuli for the signal transduction of inflammatory cytokines and MAP kinase in cardiomyocytes. Signal transduction leads to changes in structural proteins and proteins that regulate excitation-contraction. Dilated cardiomyopathy mutations result in a reduced force of the sarcomere contraction and a reduction in sarcomere content. Hypertrophic cardiomyopathy mutations result in a molecular phenotype of hyperdynamic contractility, poor relaxation, and increased energy consumption. o Option B: Cardiomyopathy is a heart muscle disease of unknown origin. In cardiomyopathy, the heart muscle becomes enlarged, thick, or rigid. In rare cases, the muscle tissue in the heart is replaced with scar tissue. o Option C: Myocarditis refers to inflammation of the heart muscle. It is an inflammatory disease of the myocardium with a wide range of clinical presentations, from subtle to devastating. o Option D: Pericarditis is an inflammation of the pericardium. Pericarditis is usually acute – it develops suddenly and may last up to several months. The condition usually clears up after 3 months, but sometimes attacks can come and go for years. When a client has pericarditis, the membrane around the heart is red and swollen, like the skin around a cut that becomes inflamed. Sometimes there is extra fluid in the space between the pericardial layers, which is called pericardial effusion. • 72. Question Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following conditions? o A. Pericarditis o B. Hypertension o C. Obliterative 66 o Option A: Pericarditis is exhibited by a feeling of fullness in the chest and auscultation of a pericardial friction rub. o Option B: Hypertension is usually exhibited by headaches, visual disturbances, and a flushed face. Myocardial infarction causes heart failure but isn’t related to these symptoms. o Option C: Obliterative cardiomyopathy is very rare. It may result from the end stage of eosinophilic syndromes, in which intracavitary thrombus fills the left ventricular apex and hampers the filling of the ventricles. Correct Answer: D. Restrictive These are the classic symptoms of heart failure. Heart failure is the pathophysiologic state in which the heart, via an abnormality of cardiac function (detectable or not), fails to pump blood at a rate commensurate with the requirements of the metabolizing tissues or is able to do so only with an elevated diastolic filling pressure. Correct Answer: B. Hypertrophic Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. Three explanations for the systolic anterior motion of the mitral valve have been offered, as follows: (1) the mitral valve is pulled against the septum by contraction of the papillary muscles, which occurs because of the valve’s abnormal location and septal o D. Restrictive • 73. Question Which of the following types of cardiomyopathy does not affect cardiac output? o A. Dilated o B. Hypertrophic o C. Restrictive o D. Obliterative 67 Correct Answer: D. Failure of the ventricle to eject all the blood during systole An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. This increased resistance is related to decreased compliance of the ventricle. hypertrophy altering the orientation of the papillary muscles; (2) the mitral valve is pushed against the septum because of its abnormal position in the outflow tract; (3) the mitral valve is drawn toward the septum because of the lower pressure that occurs as blood is ejected at high velocity through a narrowed outflow tract (Venturi effect). o Option A: Dilated cardiomyopathy causes a decrease in cardiac output. Progressive dilation can lead to significant mitral and tricuspid regurgitation, which may further diminish the cardiac output and increase end-systolic volumes and ventricular wall stress. In turn, this leads to further dilation and myocardial dysfunction. o Option C: Restrictive cardiomyopathy causes decreased cardiac output. Reduced LV filling leads to reduced stroke volume resulting in low cardiac output symptoms such as fatigue and lethargy. Increased filling pressures cause pulmonary and systemic congestion and symptomatic dyspnea. o Option D: Obliterative cardiomyopathy may affect cardiac output because a thrombus hampers ventricular filling, which may decrease the cardiac output. • 74. Question Which of the following cardiac conditions does a fourth heart sound (S4) indicate? o A. Dilated aorta o B. Normally functioning heart o C. Decreased myocardial contractility o D. Failure of the ventricle to eject all the blood during systole