Deck 31: Disorders of Ventilation and Gas Exchange

Question 1

In which of the following patient situations would a physician be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient's health problems?

A) A 61-year-old man whose ECG was characterized by widespread T-wave inversions on admission but whose T waves have recently normalized
B) ^{A 77-year-old with diminished S}3 ^{and S}4 ^{heart tones, irregular heart rate, and a} history of atrial fibrillation
C) A 56-year-old obese man who is complaining of chest pain that is exacerbated by deep inspiration and is radiating to his neck and scapular ridge
D) A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels

Answer 1

^{A 77-year-old with diminished S}3 ^{and S}4 ^{heart tones, irregular heart rate, and a} history of atrial fibrillation

Question 2

Following cardiac surgery, the nurse suspects the patient may be developing a cardiac tamponade. Which of the following clinical manifestations would support this diagnosis? Select all that apply.

A) Muffled heart tones
B) Narrowed pulse pressure
C) Low BP-84/60
D) Heart rate 78
E) Bounding femoral pulse

Answer 2

Muffled heart tones
Narrowed pulse pressure
Low BP-84/60

Question 3

Which of the following phenomena would be most likely to accompany increased ^{myocardial oxygen demand (MVO}2^)?

A) Inadequate ventricular end-diastolic pressure
B) Use of calcium channel blocker medications
C) Increased aortic pressure
D) Ventricular atrophy

Answer 3

Increased aortic pressure

Question 4

As part of the diagnostic workup for a male client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care?

A) Echocardiogram, PET scan, ECG
B) Ambulatory ECG, cardiac MRI, echocardiogram
C) Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy
D) Cardiac catheterization, cardiac CT, exercise stress testing

Question 5

Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?

A) "People with plaque in their arteries experience attacks of blood flow disruption at seemingly random times."
B) "The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel."
C) "Infections of any sort are often a signal that plaque disruption is in danger of occurring."
D) "The impaired function of the lungs that accompanies pneumonia or chronic obstructive pulmonary disease is a precursor to plaque disruption."

Question 6

Four patients were admitted to the emergency department with severe chest pain. All were given preliminary treatment with aspirin, morphine, oxygen, and nitrates and were monitored by ECG. Which patient most likely experienced myocardial infarction?

A) A 33-year-old male whose pain started at 7 AM during moderate exercise and was relieved by nitrates; ECG was normal; cardiac markers remained stable.
B) A 67-year-old female whose pain started at 2 AM while she was asleep and responded to nitrates; the ECG showed arrhythmias and ST-segment elevation; cardiac markers remained stable.
C) An 80-year-old woman whose pain started at 6 AM shortly after awakening and was not relieved by nitrates or rest; the ECG showed ST-segment elevation with inverted T waves and abnormal Q waves; levels of cardiac markers subsequently rose.
D) A 61-year-old man whose pain started at 9 AM during a short walk and responded to nitrates, but not to rest; ECG and cardiac markers remained stable, but anginal pattern worsened.

Question 7

Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome?

A) Increased serum creatinine and troponin I as a result of enzyme release from damaged cells
B) Increased serum potassium and decreased sodium as a result of myocardial cell lysis, release of normally intracellular potassium, and disruption of the sodium-potassium pump
C) Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation
D) Low circulatory levels of myoglobin and creatine kinase as a result of the inflammatory response

Question 8

A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)?

A) A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort
B) A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin
C) A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw
D) A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

Question 9

Following a ST-segment myocardial infarction (STEMI), the nurse should be assessing the patient for which of the following complications? Select all that apply.

A) Large amount of pink, frothy sputum and new onset of murmur
B) Tachypnea with respiratory distress
C) Frequent ventricular arrhythmia unrelieved with amiodarone drip
D) Complaints of facial numbness and tingling
E) Enhanced renal perfusion as seen as an increase in urine output

Question 10

A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points should the physician include in his explanation of the man's new diagnosis?

A) "I'll be able to help track the course of your angina through regular blood work that we will schedule at a lab in the community."
B) "With some simple lifestyle modifications and taking your heparin regularly, we can realistically cure you of this."
C) "I'm going to start you on low-dose aspirin,and it will help greatly if you can lose weight and keep exercising."
D) "There are things you can do to reduce the chance that you will need a heart bypass, including limiting physical activity as much as possible."

Question 11

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?

A) Lisinopril, an ACE inhibitor
B) Lasix, a diuretic
C) Propranolol, a $\beta$ -adrenergic blocker
D) Lanoxin, an inotropic

Question 12

Which of the following ECG patterns would the nurse observe in a patient admitted for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D)? Select all that apply.

A) Atrial flutter
B) Ventricular tachycardia with left bundle branch block pattern
C) T-wave inversion in the right precordial leads
D) Sinus arrhythmia with a first-degree AV block
E) Development of a "U" wave following a normal T wave

Question 13

A 31-year-old African American female who is in her 30th week of pregnancy has been diagnosed with peripartum cardiomyopathy. Which of the following statements best captures an aspect of peripartum cardiomyopathy?

A) Her diagnosis might be attributable to a disordered immune response, nutritional factors, or infectious processes.
B) Treatment is possible in postpartum women, but antepartum women are dependent on spontaneous resolution of the problem.
C) Mortality exceeds 50%, and very few surviving women regain normal heart function.
D) Symptomatology mimics that of stable angina and is diagnosed and treated similarly.

Question 14

An IV drug abuser walks into the ED telling the nurse that, "he is sick." He looks feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The assessment reveals a loud murmur. An echocardiogram was ordered that shows a large vegetation growing on his mitral valve. The patient is admitted to the ICU. The nurse will be assessing this patient for which possible life-threatening complications?

A) Systemic emboli, especially to the brain
B) Petechial hemorrhages under the skin and nail beds
C) GI upset from the massive amount of antibiotics required to kill the bacteria
D) Pancreas enlargement due to increased need for insulin secretion

Question 15

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?

A) CT of the heart, chest x-ray, and ECG
B) Echocardiogram, blood cultures, and temperature
C) ECG, blood pressure, and stress test
D) Cardiac catheterization, chest x-ray, electrolyte measurement, and white cell count

Question 16

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. His parents, who believe in "natural remedies," have been treating him with various herbal preparations without success and are now seeking antibiotic treatment. Throat cultures show infection with group A streptococci. This child is at high risk for

A) myocarditis.
B) mitral valve stenosis.
C) infective endocarditis.
D) vasculitis.

Question 17

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,

A) "It would be caused by stress. Let's keep our eye on it and see if it goes away with your next visit."
B) "This could be caused by an infection. Have you been feeling well the past few weeks?"
C) "One of your heart valves is not opening properly. We need to do an echocardiogram to see which valve is having problem."
D) "This may make you a little more fatigued than usual. Let me know if you start getting dizzy or light-headed."

Question 18

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?

A) "The normal tissue that makes up the valve between the right sides of your heart has stiffened."
B) "Your mitral valve isn't opening up enough for blood to flow into the part of your heart that sends blood into circulation."
C) "Your heart's mitral valve isn't closing properly so blood is flowing backward in your heart and eventually into your lungs."
D) "The valve between your left ventricle and left atria is infected and isn't allowing enough blood through."

Question 19

A 66-year-old client's echocardiogram report reveals a hypertrophied left ventricle. The health care provider suspects the client has aortic stenosis. Which of the following clinical manifestations would be observed if this client has aortic stenosis? Select all that apply.

A) Decrease in exercise tolerance
B) Exertional dyspnea
C) Palpitations
D) Syncope
E) Heartburn

Question 20

Which of the following situations related to transition from fetal to perinatal circulation would be most likely to necessitate medical intervention?

A) Pressure in pulmonary circulation and the right side of the infant's heart fall markedly.
B) Alveolar oxygen tension increases causing reversal of pulmonary vasoconstriction of the fetal arteries.
C) Systemic vascular resistance and left ventricular pressure are both increasing.
D) Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant's first week.

Question 21

A pediatric nurse is assessing a newborn diagnosed with persistent patency of the ductus arteriosus. Which of the following findings are associated with this heart defect? Select all that apply.

A) Murmur heard at the second intercostal space, during both systole and diastole
B) BP 84/30 classified as a wide pulse pressure
C) Shortness of breath with activity such as kicking
D) Stridor with inspiratory wheezes
E) Bulging jugular neck veins

Question 22

A nurse who works on a pediatric cardiology unit of a hospital is providing care for an infant with a diagnosis of tetralogy of Fallot. Which of the following pathophysiologic results should the nurse anticipate?

A) There is a break in the normal wall between the right and left atria that results in compromised oxygenation
B) The aortic valve is stenotic, resulting in increased afterload.
C) Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.
D) The right ventricle is atrophic as a consequence of impaired myocardial blood supply.