Deck 8: Chest Disorders

Question 1

In mitral stenosis,p waves may suggest:

A) Left atrial enlargement
B) Right atrial enlargement
C) Left ventricle enlargement
D) Right ventricle enlargement

Answer 1

Left atrial enlargement

Question 2

What is the most common valvular heart disease in the older adult?

A) Aortic regurgitation
B) Aortic stenosis
C) Mitral regurgitation
D) Mitral stenosis

Answer 2

Aortic stenosis

Question 3

The best way to diagnose structural heart disease/dysfunction non-invasively is:

A) Chest x-ray
B) EKG
C) Echocardiogram
D) Heart catheterization

Answer 3

Echocardiogram

Question 4

Susan P. ,a 60-year-old woman with a 30 pack year history,presents to your primary care practice for evaluation of a persistent,daily cough with increased sputum production,worse in the morning,occurring over the past three months.She tells you,"I have the same thing,year after year." Which of the following choices would you consider strongly in your critical thinking process?

A) Seasonal allergies
B) Acute bronchitis
C) Bronchial asthma
D) Chronic bronchitis

Question 5

Ischemic heart disease is:

A) Defined as imbalance between oxygen supply and demand.
B) Frequently is manifested as angina.
C) Leading cause of death in the elderly.
D) All of the above.

Question 6

The aging process causes what normal physiological changes in the heart?

A) The heart valve thickens and becomes rigid,secondary to fibrosis and sclerosis
B) Cardiology occurs along with prolapse of the mitral valve and regurgitation
C) Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid valves
D) Hypertrophy of the right ventricle

Question 7

Preceding a stress test,the following lab work might include:

A) CBC and differential to differentiate ischemic heart disease from anemia
B) Liver enzymes to rule out underlying gall bladder disease
C) Thyroid studies to rule out hyperthyroidism
D) A & C only

Question 8

Jose M.is a 68-year-old man who presents to your primary care practice for a physical.Jose has had type 2 diabetes mellitus for 5 years,diet controlled.His BMI is 32.Smoker, pack per day for 25 years.He denies other medical problems.Family history includes CAD,CABG x4 for father,now deceased;CHF,type 2 diabetes mellitus,HT for mother.According to the AHA/ACC guidelines,what stage is Jose?

A) Stage A
B) Stage B
C) Stage C
D) Stage D

Question 9

The best evidence rating drugs to consider in a post myocardial infarction patient include:

A) ASA,ACE/ARB,beta-blocker,aldosterone blockade
B) Ace,ARB,Calcium channel blocker,ASA
C) Long-acting nitrates,warfarin,ACE,and ARB
D) ASA,clopidogrel,nitrates

Question 10

An older adult may present with atypical clinical signs of pneumonia.The nurse practitioner needs to be aware that the clustering of all of the following signs and symptoms may be indicative of pneumonia in an older person except:

A) Bradycardia
B) Malaise
C) Anorexia
D) Confusion

Question 11

Which test is the clinical standard for the assessment of aortic stenosis?

A) Cardiac catheterization
B) Stress test
C) Chest x-ray
D) Echocardiography

Question 12

Which of the following statements is true concerning anti-arrhythmic drugs?

A) Amiodarone is the only one not associated with increased mortality and it has a very favorable side effect profile.
B) Both long-acting and short-acting calcium channel blockers are associated with an increased risk of cardiovascular morbidity and mortality.
C) Most anti-arrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic.
D) Anti-arrhythmic therapy should be initiated in the hospital for all patients.

Question 13

On examination,what type of murmur can be auscultated with aortic regurgitation?

A) Austin flint
B) Systolic ejection
C) Soft S1 and a Loud S2
D) Loud S1

Question 14

Dan G. ,a 65-year-old man,presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain.Pain begins after strenuous activity,including walking.Pain is characterized as dull,aching;8/10 during activity,otherwise 0/10.Began a few months ago,intermittent,aggravated by exercise,and relieved by rest.Has occasional nausea.Pain is retrosternal,radiating to left shoulder,definitely affects quality of life by limiting activity.Pain is worse today;did not go away after he stopped walking.BP 120/80.Pulse 72 and regular.Normal heart sounds,S1 and S2,no murmurs.Which of the following differential diagnoses would be most likely?

A) Musculoskeletal chest wall syndrome with radiation
B) Esophageal motor disorder with radiation
C) Acute cholecystitis with cholelithiasis
D) Coronary artery disease with angina pectoris

Question 15

Which test is the clinical standard for the assessment of aortic stenosis?

A) Cardiac catheterization
B) Stress test
C) Chest x-ray
D) Echocardiography

Question 16

The organism most commonly responsible for community-acquired pneumonia in older adults is:

A) Pseudomonas aeruginosa
B) Staphylococcus aureus
C) Proteus mirabilis
D) Streptococcus pneumonia

Question 17

A key symptom of ischemic heart disease is chest pain.However,angina equivalents may include exertional dyspnea.Angina equivalents are important because:

A) Women with ischemic heart disease many times do not present with chest pain
B) Some patients may have no symptoms or atypical symptoms.Diagnosis may only be made at the time of an actual myocardial infarction
C) Elderly patients have the most severe symptoms
D) A & B only

Question 18

A common auscultatory finding in advanced CHF is:

A) Systolic ejection murmur
B) S3 gallop rhythm
C) Friction rub
D) Bradycardia

Question 19

A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion.There were no complaints of chest pain.Her ECG indicates normal sinus rhythm without ST segment abnormalities.Your plan may include:

A) Echocardiogram
B) Exercise stress test
C) Cardiac catheterization
D) Myocardial perfusion imaging

Question 20

Aortic regurgitation requires medical treatment for early signs of CHF with:

A) Beta blockers
B) ACE inhibitors
C) Surgery
D) Hospitalization

Question 21

A 72-year-old woman and her husband are on a cross-country driving vacation.After a long day of driving,they stop for dinner.Midway through the meal,the woman becomes very short of breath,with chest pain and a feeling of panic.Which of the following problems is most likely?

A) Pulmonary edema
B) Heart failure
C) Pulmonary embolism
D) Pneumonia