Disorders of the Cardiovascular System essay

Disordersof the Cardiovascular System

Disordersof the Cardiovascular System

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Question 1. 1. A 68-year-old male complains to his nurse practitioner that when he tests his blood pressure using a machine at his pharmacy, his heart rate is nearly always very low. At other times, he feels that his heart is racing, and it also seems to pause at times. The man has also occasionally had lightheadedness and a recent syncopal episode. What is this patient`s most likely diagnosis and the phenomenon underlying it? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Ventricular arrhythmia as a result of alternating vagal and sympathetic stimulation&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Torsades de pointes as a result of disease of the bundle of His&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Premature atrial contractions that vacillate between tachycardic and bradycardic episodes as a consequence of an infectious process

Question 2. 2. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Increased preload due to vascular resistance&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp High afterload because of backpressure against the left ventricle&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Impaired contractility due to aortic resistance&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Systolic impairment because of arterial stenosis

Question 3. 3. An 81-year-old female patient of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the patient has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the patient`s condition? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Peripheral dilation is associated with decreased stroke volume and ejection fraction.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Heart valves are not capable of preventing backflow in cases of atrial congestion.

Question 4. 4. An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp An increase in preload via the Frank-Starling mechanism&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP)&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp AV node pacemaking activity and vagal nerve suppression

Question 5. 5. A patient has suffered damage to his pericardium following a motor vehicle accident. Which of the following consequences should the nurse practitioner be most likely to rule out? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Impaired physical restraint of the left ventricule&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Increased friction during the contraction/relaxation cycle&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Reduced protection from infectious organisms&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Impaired regulation of myocardial contraction

Question 6. 6. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician. As part of the patient`s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Holter monitors are normally set to record electrical activity of the heart at least once per hour.

Question 7. 7. A 70-year-old male patient presents to the emergency department complaining of pain in his calf that is exacerbated when he walks. His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened. What would his care provider`s preliminary diagnosis and anticipated treatment most likely be? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Acute arterial occlusion that will be treated with angioplasty&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Raynaud disease that will require antiplatelet medications&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Atherosclerotic occlusive disease necessitating thrombolytic therapy&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Giant cell temporal arteritis that will be treated with corticosteroids

Question 8. 8. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp 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. 9. An older adult female patient has presented with a new onset of shortness of breath, and the patient`s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner`s choice of blood work? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient`s dyspnea from a respiratory pathology.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp BNP levels correlate with the patient`s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

Question 10. 10. Which of the following assessment findings in a newly admitted 30-year-old male patient would be most likely to cause his nurse practitioner to suspect polyarteritis nodosa? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The man`s blood work indicates polycythemia (elevated red cells levels) and leukocytosis (elevated white cells).&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The man`s blood pressure is 178/102 and he has abnormal liver function tests.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The man is acutely short of breath and his oxygen saturation is 87%.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The man`s temperature is 101.9°F and he is diaphoretic (heavily sweating).

Question 11. 11. A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia and she is suspected of having sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Signal-averaged ECG&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Exercise stress testing&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Electrophysiologic study&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Holter monitoring

Question 12. 12. A nurse practitioner has ordered the measurement of a cardiac patient`s electrolyte levels as part of the patient`s morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient`s heart? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential.

Question 13. 13. A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks` gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Plasma angiotensin I and II and renin&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Urinary sodium and potassium&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Platelet count, serum creatinine, and liver enzymes&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Urinary catecholamines and metabolites

Question 14. 14. The nurse practitioner for a cardiology practice is responsible for providing presurgical teaching for patients who are about to undergo a coronary artery bypass graft. Which of the following teaching points best conveys an aspect of the human circulatory system? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Your blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation.”&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Only around one quarter of your blood is in your heart at any given time.”&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Blood pressure and blood volume roughly mimic one another at any given location in the circulatory system.”&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Left-sided and right-sided pumping action at each beat of the heart must equal each other to ensure adequate blood distribution.”

Question 15. 15. A 66-year-old patient`s echocardiogram reveals a hypertrophied left ventricle, normal chamber volume, and a normal ejection fraction from the heart. What is this patient`s most likely diagnosis? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Mitral valve regurgitation&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Aortic valve stenosis&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Mitral valve stenosis&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Aortic valve regurgitation

Question 16. 16. Which of the following situations related to the transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? (Points : 0.4)

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

Question 17. 17. A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Resolution of compensatory pulmonary edema and heart arrhythmias&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Infusion of normal saline of Ringer lactate to maintain the vascular space&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Administration of oxygen and epinephrine to promote perfusion

Question 18. 18. A nurse practitioner is teaching a student NP about the physiologic basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by the student would warrant correction by the nurse practitioner? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “As vessel wall thickness increases, tension decreases.”&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Smaller blood vessels require more pressure to overcome wall tension.”&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “The smaller the vessel radius, the greater the pressure needed to keep it open.”&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Tension and vessel thickness increase proportionately.”

Question 19. 19. A nurse practitioner is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp A 61-year-old man who has a heart valve infection and recurrent fever&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

Question 20. 20. An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure. Which of the following components of the pathologist`s report is most suggestive of a possible history of poorly controlled blood pressure? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Scarring of urethra suggestive of recurrent urinary tract infections is evident.”&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Bilateral renal hypertrophy noted.”&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Vessel wall changes suggestive of venous stasis are evident.”&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Arterial sclerosis of subcortical brain regions noted.”

Question 21. 21. A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his nurse practitioner. The patient`s nurse practitioner would anticipate that which of the following phenomena is most likely occurring? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The patient`s juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.

Question 22. 22. A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right. In addition, her femoral pulses are weak bilaterally. Which of the following possibilities would her care provider be most likely to suspect? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Pheochromocytoma&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Essential hypertension&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp Coarctation of the aorta&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp An adrenocortical disorder

Question 23. 23. A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was “so fast I couldn`t even count it.” The child was determined to be in atrial flutter and his mother is seeking an explanation from the health care team. Which of the following points should underlie an explanation to the mother? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The child is experiencing a reentry rhythm in his right atrium.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The child is likely to have a normal ECG apart from the rapid heart rate.&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp The boy`s atria are experiencing abnormal sympathetic stimulation.

Question 24. 24. A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol. Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Remember, the `H` in HDL and the `L` in LDL correspond to high danger and low danger to your health.”&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Having high cholesterol increases your risk of developing diabetes and irregular heart rate.”&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Smoking and being overweight increases your risk of primary hypercholesterolemia.”&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp “Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk.”

Question 25. 25. In which of the following patient situations would a nurse practitioner be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient`s health problems? (Points : 0.4)

&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp A 61-year-old man whose ECG was characterized by widespread T wave inversions on admission but whose T waves have recently normalized&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp A 77-year-old with diminished S3 and S4 sounds, an irregular heart rate, and a history of atrial fibrillation&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp 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&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels

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Waldstein,S. R., &amp Elias, M. F. (Eds.). (2015). Neuropsychologyof cardiovascular disease.