Exam 14
Exam 14
1. Which of the following procedures most specifically describes splitting or separating fused
cardiac valve leaflets?
A. Commisurotomy
B. Annuloplasty
C. Chordoplasty
D. Valvuloplasty
Valvuloplasty is a general term that refers to repair of a stenosed or regurgitant cardiac valve by
commisurotomy, annuloplasty, leaflet repair, and/or chordoplasty.
A. Prolapse
Mitral valve prolpase is a deformity that usually produces no symptoms and has been diagnosed
more frequently in recent years, probably as a result of improved diagnostic methods.
B. Stenosis
C. Regurgitation
Mitral valve regurgitation, in its acute stage, usually presents as severe heart failure.
D. Infection
Mitral valve infection, when acute, will produce symptoms typical of infective endocarditis.
3. In which type of cardiomyopathy does the heart muscle actually increase in size and mass
weight, especially along the septum?
A. Hypertrophic
Because of the structural changes, hypertrophic cardiomyopathy had also been called idiopathic
hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH).
B. Dilated
Because of the structural changes, hypertrophic cardiomyopathy had also been called idiopathic
hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH).
C. Restrictive
Arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs when the myocardium of the
right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue
4. Which of the following patient behaviors, if observed by the nurse, would indicate that the
cardiac patient’s level of anxiety has decreased?
Generally, when anxiety begins to increase, the patient will be less likely to want to discuss
prognosis.
Verbalization of fears and concerns indicates some degree of comfort with prognosis.
5. The patient with which of the follow characteristics is considered high risk for the
development of infective endocarditis?
C. Hypertrophic cardiomyopathy
The patient with hypertrophic cardiomyopathy is at moderate risk for the development of
infective endocarditis.
The patient with acquired valvular dysfunction is at moderate risk for the development of
infective endocarditis.
6. Which of the following terms indicates the amount of blood pumped out of the ventricle with
each contraction of the heart?
A. Stroke volume
Stroke volume is the amount of blood pumped out (ejected) with each contraction of the heart
(heart beat). Stroke volume times heart rate equals cardiac output.
B. Afterload
C. Cardiac output
Cardiac output is the amount of blood pumped out of the heart in one minute.
D. Preload
Preload is the pressure created by a volume of blood within a ventricle before contraction.
7. When the balloon on the distal tip of a pulmonary artery catheter is inflated and a pressure is
measured, the measurement obtained is referred to as the
When the balloon is inflated, the tip of the catheter floats into smaller branches of the
pulmonary arty until it can no longer be passed and the pressure is recorded, reflecting left atrial
pressure and left ventricular end-diastolic pressure.
Pulmonary artery pressure is measured when the balloon tip is not inflated.
D. cardiac output.
Cardiac output is determined through thermodilution involving injection of fluid into the
pulmonary artery catheter.
A. Furosemide (Lasix)
B. Chlorothiazide (Diuril)
C. Chlorthalidone (Hygroton)
D. Spironolactone (Aldactone)
9. When the nurse observes that the patient always has difficulty breathing when lying flat, the
nurse records that the patient is demonstrating
A. Orthopnea
Patients with orthopnea prefer not to lie flat and will need to maintain their beds in a semi- to
high Fowler’s position
B. Dyspnea on exertion.
C. Hyperpnea.
10. The patient with cardiac failure is taught to report which of the following symptoms to the
physician or clinic immediately?
A. Persistent cough
C. Weight loss
A. Tissue hypoperfusion
12. Vasoactive drugs which cause the arteries and veins to dilate, thereby shunting much of the
intravascular volume to the periphery and causing a reduction in preload and afterload include
agents such as
B. Norepinephrine (Levophed)
Norepinephrine (Levophed) is a vasopressor that is used to promote perfusion to the heart and
brain.
C. Dopamine (Inotropin)
Dopamine (Inotropin) tends to increase the workload of the heart by increasing oxygen demand;
thus, it is not administered early in the treatment of cardiogenic shock.
D. Furosemide (Lasix)
Furosemide (Lasix) is a loop diuretic that reduces intravascular fluid volume.
13. Which of the following terms refers to a muscular, cramp-like pain in the extremities
consistently reproduced with the same degree of exercise and relieved by rest?
A. Intermittent claudication
B. Aneurysm
An aneurysm is a localized sac of an artery wall formed at a weak point in the vessel.
C. Bruit
A bruit is the sound produced by turbulent blood flow through an irregular, tortuous, stenotic,
or dilated vessel.
D. Ischemia
14. Which of the following observations regarding ulcer formation on the patient’s lower
extremity indicate to the nurse that the ulcer is a result of venous insufficiency?
The base of a venous insufficiency ulcer shows beefy red to yellow fibrinous color.
15. A diagnostic test that involves injection of a contrast media into the venous system through
a dorsal vein in the foot is termed
A. contrast phlebography.
When a thrombus exists, an x-ray image will disclose an unfilled segment of a vein.
B. air plethysmography
Air plethysmography quantifies venous reflux and calf muscle pump ejection.
C. lymphangiography.
D. lymphoscintigraphy.
16. The nurse teaches the patient with peripheral vascular disease to refrain from smoking
because nicotine causes
A. vasospasm.
Nicotine causes vasospasm and can thereby dramatically reduce circulation to the extremities.
Nicotine does not suppress cough. Smoking irritates the bronchial tree, causing coughing.
D. diuresis.
17. Which of the following types of aneurysms results in bleeding into the layers of the arterial
wall?
A. Dissecting
Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal
and medial layers of the arterial wall.
B. Saccular
C. False
D. Anastomotic
18. Which of the following terms refers to enlarged, red, and tender lymph nodes?
A. Lymphadenitis
B. Lymphangitis
C. Lymphedema
D. Elephantiasis
Elephantiasis refers to a condition in which chronic swelling of the extremity recedes only
slightly with elevation.
19. Which of the following terms is given to hypertension in which the blood pressure, which is
controlled with therapy, becomes uncontrolled (abnormally high) with the discontinuation of
therapy?
A. Rebound
B. Essential
Essential or primary hypertension denotes high blood pressure from an unidentified source.
C. Primary
Essential or primary hypertension denotes high blood pressure from an unidentified source.
D. Secondary
Secondary hypertension denotes high blood pressure from an identified cause, such as renal
disease.
20. Officially, hypertension is diagnosed when the patient demonstrates a systolic blood
pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg
over a sustained period.
A. 140, 90
According to the categories of blood pressure levels established by the JNC VI, stage 1
hypertension is demonstrated by a systolic pressure of 140–159 or a diastolic pressure of 90–99.
B. 130, 80
Pressure of 130 systolic and 80 diastolic falls within the normal range for an adult.
C. 110, 60
Pressure of 110 systolic and 60 diastolic falls within the normal range for an adult.
D. 120, 70
Pressure of 120 systolic and 70 diastolic falls within the normal range for an adult.
21. The nurse teaches the patient which of the following guidelines regarding lifestyle
modifications for hypertension?
In general, one serving of a potassium-rich food such as banana, kale, broccoli, or orange juice
will meet the daily need for potassium.
The general guideline is to advise the patient to increase aerobic activity to 30 to 45 minutes
most days of the week.
In general, alcohol intake should be limited to no more than 1 oz of ethanol per day.
A. Spironolactone (Aldactone)
B. Furosemide (Lasix)
C. Chlorothiazide (Diuril)
D. Chlorthalidone (Hygroton)
Minipress is a peripheral vasodilator acting directly on the blood vessel. It is not used in angina
and coronary artery disease, however, because it induces tachycardia if not preceded by
administration of propranolol and a diuretic.
B. Reserpine (Serpasil)
C. Propranolol (Inderal)
Inderal blocks the beta-adrenergic receptors of the sympathetic nervous system, especially the
sympathetics to the heart, producing a slower heart reate and lowered blood pressure.
Catapres acts through the central nervous system, apparently through centrally mediated alpha-
adrenergic stimulation in the brain, producing blood pressure reduction.
24. Which of the following terms refers to an abnormal decrease in white blood cells, red blood
cells, and platelets?
A. Pancytopenia
B. Anemia
C. Leukopenia
D. Thrombocytopenia
25. Which of the following terms refers to a form of white blood cell involved in immune
response?
A. Lymphocyte
C. Spherocyte
A spherocyte is a red blood cell without central pallor, seen with hemolysis.
D. Thrombocyte
A thombocyte is a platelet.
26. The term that is used to refer to a primitive cell, capable of self-replication and
differentiation, is
A. stem cell.
B. band cell.
C. spherocyte.
D. reticulocyte.
D. Hypersplenism
A. protamine sulfate.
Protamine sulfate, in the appropriate dosage, acts quickly to reverse the effects of heparin.
B. vitamin K.
C. Narcan.
Narcan is the drug used to reverse signs and symptoms of medication-induced narcosis.
D. Ipecac.
29. Which of the following terms describes a gastric secretion that combines with vitamin B-12
so that it can be absorbed?
A. Intrinsic factor
B. Amylase
C. Pepsin
D. Trypsin
30. When bowel sounds are heard about every 15 seconds, the nurse would record that the
bowel sounds are
A. normal.
B. hypoactive.
Hypoactive bowel sounds is the description given to auscultation of one to two bowel sounds in
2 minutes.
C. sluggish.
Sluggish is not a term a nurse would use to accurately describe bowel sounds.
D. absent.
The nurse records that bowel sounds are absent when no sound is heard in 3-5 minutes.
31. When gastric analysis testing reveals excess secretion of gastric acid, which of the following
diagnoses is supported?
A. Duodenal ulcer
Patients with duodenal ulcers usually secrete an excess amount of hydrochloric acid.
C. Gastric cancer
D. Pernicious anemia
Patients with pernicious anemia secrete no acid under basal conditions or after stimulation.
32. Which of the following terms is used to describe stone formation in a salivary gland, usually
the submandibular gland?
A. Sialolithiasis
B. Parotitis
C. Sialadenitis
D. Stomatitis
33. Irritation of the lips associated with scaling, crust formation, and fissures is termed
A. leukoplakia.
Lichen planus refers to white papules at the intersection of a network of interlacing lesions.
C. actinic cheilitis.
D. chancre.
34. Regarding oral cancer, the nurse provides health teaching to inform the patient that
As the cancer progresses, the patient may complain of tenderness or difficulty in chewing,
swallowing, or speaking.
The most frequent symptom of oral cancer is a painless sore that will not heal.
A typical lesion in oral cancer is a painless hardened ulcer with raised edges.
A. dysphagia.
This symptom may vary from an uncomfortable feeling that a bolus of food is caught in the
upper esophagus to acute pain on swallowing.
B. nausea.
C. vomiting.
D. odynophagia.
A. esophageal diverticula.
Because the diverticula may retain decomposed food, halitosis and a sour taste in the mouth are
frequent complaints.
B. achalasia.
C. gastroesophageal reflux.
D. hiatal hernia.
Hiatal hernia presents as heartburn, regurgitation, and dysphagia in many patients while at least
50% are asymptomatic.
37. Which of the following terms refers to the symptom of gastroesophageal reflux disease
(GERD) which is characterized by a burning sensation in the esophagus?
A. Pyrosis
B. Dyspepsia
C. Dysphagia
D. Odynophagia
38. The nurse teaches the patient with gastroesophageal reflux disease (GERD) which of the
following measures to manage his disease?
B. Minimize intake of caffeine, beer, milk, and foods containing peppermint and spearmint.
The patient should be instructed to avoid the listed foods and food components.
The patient should be instructed to elevate the head of the bed on 6- to 8-inch blocks.
39. Which of the following statements accurately describes cancer of the esophagus?
In the United States, cancer of the esophagus has been associated with the ingestion of alcohol
and the use of tobacco.
In the United States, carcinoma of the esophagus occurs more than three times as often in men
as in women.
40. Which of the following venous access devices can be used for no more than 30 days in
patients requiring parenteral nutrition?
A. Non-tunneled catheter
The subclavian vein is the most common vessel used because the subclavian area provides a
stable insertion site to which the catheter can be anchored, allows the patient freedom of
movement, and provides easy access to the dressing site.
C. Tunneled catheters
Tunneled central catheters are for long-term use and may remain in place for many years.
D. Implanted ports
Implanted ports are devices also used for long term home IV therapy (eg, Port A Cath, Mediport,
Hickman Port, P.A.S. Port).
41. To ensure patency of central venous line ports, dilute heparin flushes are used in which of
the following situations?
Daily instillation of dilute heparin flush when a port is not in use will maintain the port.
Continuous infusion maintains the patency of each port. Heparin flushes are used after each
intermittent infusion.
Heparin flushes are used after blood drawing in order to prevent clotting of blood within the
port.
42. For which of the following medications must the nurse contact the pharmacist in
consultation when the patient receives all oral medications by feeding tube?
A. Enteric-coated tablets
Enteric-coated tablets are meant to be digested in the intestinal tract and may be destroyed by
stomach acids. A change of form of medication is required by patients with tube feedings.
Simple compressed tablets may be crushed and dissolved in water for patient receiving oral
medications by feeding tube.
Buccal or sublingual tablets are absorbed by mucous membranes and may be given as intended
to the patient undergoing tube feedings.
The nurse may make an opening in the capsule and squeeze out contents for administration by
feeding tube.
B. Decompression
A gastric sump and nasoenteric tube are used for gastrointestinal decompression.
C. Aspiration
D. Emptying
Gastric sump tubes are used to decompress the stomach and keep it empty.
44. Mercury is typically used in the placement of which of the following tubes?
A. Miller-Abbott
Most nasoenteric tubes use mercury to carry the tube by gravity to its desired location.
B. Gastric sump
C. Dobbhoff
D. EnterafloW
45. The most significant nursing problem related to continuous tube feedings is
B. interruption of GI integrity
Tube feedings preserve the normal sequence of intestinal and hepatic metabolism.
D. interruption in fat metabolism and lipoprotein synthesis
46. When the nurse prepares to give a bolus tube feeding to the patient and determines that
the residual gastric content is 150 cc, her best action is to
If the gastric residual exceeds 100 cc 2 hours in a row, the physician should be notified.
One observation of a residual gastric content over 100 cc does not have to be reported to the
physician. If the observation occurs two times in succession, the physician should be notified.
If the amount of gastric residual exceeds 100 cc, the tube feeding should be withheld at that
time.
If the amount of gastric residual exceeds 100 cc, the tube feeding should be withheld at that
time, but not indefinitely.
47. If tube feeding is continuous, the placement of the feeding tube should be checked
A. every shift.
Each nurse caring for the patient is responsible for verifying that the tube is located in the
proper area for continuous feeding.
B. every hour.
Checking for placement each hour is unnecessary unless the patient is extremely restless or
there is basis for rechecking the tube based on other patient activities.
C. every 24 hours.
Checking for placement every 24 hours does not meet the standard of care due the patient
receiving continuous tube feedings.
Even though the feedings are continuous, the placement must be assessed.
48. Decrease in absorption of which of the following vitamins in the geriatric patient results in
pernicious anemia?
A. B12
Vitamin B12 requires the intrinsic factor secreted by the gastric mucosa for absorption.
B. C
C. D
D. B6
A. Melena
B. Hemarthrosis
C. Hematemesis
D. Pyrosis
50. Which of the following statements accurately reflects a rule of thumb upon which the nurse
may rely in assessing the patient’s fluid balance?
If food and fluids are withheld, IV fluids (3L/day) are usually prescribed.