MULTIPLE CHOICE
1. The most reliable indicator that a person is experiencing an acute myocardial infarction (MI) is
a. severe, crushing chest pain.
b.
... [Show More] ST-segment elevation.
c. dysrhythmias.
d. pain radiating to the lower legs. ANS: B
Injuries to cardiac tissue caused by myocardial ischemia and infarction are indicated on the ECG by STsegment
changes. ST-segment elevation on the ECG indicates that ischemic injury is ongoing and that
efforts to improve perfusion or reduce oxygen demand may be effective in preserving myocardial
muscle. In some instances, an MI is entirely asymptomatic. Dysrhythmias that accompany MI are
attributed to injured and ischemic cells that have not yet become necrotic. Pain radiating to the jaw and
neck, not the lower legs, is symptomatic of an MI.
2. Primary treatment for myocardial infarction (MI) is directed at
a. protecting the heart from further ischemia.
b. decreasing myocardial oxygen demands.
c. reducing heart rate and blood pressure.
d. activating the parasympathetic system.
ANS: B
Reducing oxygen demand may be effective in preserving myocardial muscle. Decreasing demand
increases myocardial oxygen supply. Once the cardiac muscle has been damaged, it is more important to
preserve remaining muscle and prevent further loss of the myocardium.
Reduction in the heart rate and blood pressure is not the primary treatment goal in MI care.
Parasympathetic activation is not the primary treatment for myocardial infarction.
3. Rheumatic heart disease is most often a consequence of
a. chronic intravenous drug abuse.
b. viral infection with herpesvirus.
c. -hemolytic streptococcal infection.
d. cardiomyopathy.
ANS: C
Rheumatic heart disease is an uncommon but serious consequence of rheumatic fever. Rheumatic fever
is an acute inflammatory disease that follows infection with group A
-hemolytic streptococci. Rheumatic heart disease is not associated with chronic IV drug abuse.
Rheumatic fever is an acute inflammatory infectious disease. Cardiomyopathy does not cause rheumatic
heart disease.
4. Patients presenting with symptoms of unstable angina and no ST segment elevation are treated
with
a. cardiac catheterization.
b. antiplatelet drugs.
c. acute reperfusion therapy.
d. cardiac biomarkers only. ANS: B
Patients presenting with symptoms of unstable angina and no ST elevation on the ECG would be treated
with antiplatelet drugs as a cornerstone of therapy. Coronary angiography may be used as an additional
method of diagnosis but would not be the primary option. The patient with symptoms of unstable
angina would not benefit from reperfusion strategies. Cardiac biomarkers may be assessed in the
unstable angina patient, but are not the primary indicator.
5. An example of an acyanotic heart defect is
a. tetralogy of Fallot.
b. transposition of the great arteries.
c. ventricular septal defect.
d. all right-to-left shunt defects. ANS: C
An example of an acyanotic heart defect is a ventricular septal defect. In this condition, blood from the
left ventricle leaks into the right ventricle because of a defect in the ventricular wall. This leakage causes
extra pressure in the right ventricle resulting in pulmonary hypertension. Tetralogy of Fallot is a cyanotic
congenital defect. Transposition of the great vessels is a cyanotic congenital defect. The category of
cyanotic congenital defects refers to those that are right-to-left shunts.
6. Patent ductus arteriosus is accurately described as a(n)
a. opening between the atria.
b. stricture of the aorta that impedes blood flow.
c. communication between the aorta and the pulmonary artery.
d. cyanotic heart defect associated with right-to-left shunt. ANS: C
A patent ductus arteriosus is a normal channel between the pulmonary artery and the aorta that
remains open during intrauterine life. A patent ductus arteriosus is not an opening or a stricture in the
atria. Patent ductus arteriosus is an acyanotic congenital defect.
7. Hypotension, distended neck veins, and muffled heart sounds are classic manifestations of
a. myocardial infarction.
b. cardiac tamponade.
c. congestive heart failure (CHF).
d. cardiomyopathy.
ANS: B
The three classic symptoms of cardiac tamponade are hypotension, distended neck veins, and muffled
heart sounds. There are many other manifestations as well. Myocardial infarction is not exhibited by the
symptoms described. Classic symptoms of cardiac tamponade are hypotension, distended neck veins,
and muffled heart sounds. Symptoms of CHF may include jugular venous distention. Cardiomyopathy is
not exhibited by the symptoms described.
8. Constrictive pericarditis is associated with
a. impaired cardiac filling.
b. cardiac hypertrophy.
c. increased cardiac preload.
d. elevated myocardial oxygen consumption. ANS: A
Constrictive pericarditis results in a fibrous scarred pericardium that restricts cardiac filling. Chronic
pericarditis may be the result of a previous cardiac surgery. Pericarditis is associated with increased
workload of the heart because contraction is opposed by the surrounding structures. The constrictive
process includes symptoms of exercise intolerance, weakness, and fatigue.
9. Mitral stenosis is associated with
a. a prominent S4 heart sound.
b. a pressure gradient across the mitral valve.
c. left ventricular hypertrophy.
d. a muffled second heart sound (S2). ANS: B
Mitral stenosis is characterized by an abnormal left atrial–left ventricular pressure gradient during
ventricular diastole. Mitral stenosis is not associated with an S4 heart sound. Mitral stenosis is
associated with left atrial hypertrophy, not left ventricular hypertrophy. Mitral stenosis does not have a
symptom of a muffled second heart sound.
10. Aortic regurgitation is associated with
a. diastolic murmur.
b. elevated left ventricular/aortic systolic pressure gradient.
c. elevated systemic diastolic blood pressure.
d. shortened ventricular ejection phase. ANS: A
Aortic regurgitation results from an incompetent aortic valve that allows blood to leak back from the
aorta into the left ventricle during diastole. In aortic regurgitation, there is not an elevated left
ventricular/aortic pressure gradient. Diastolic blood pressure is generally lower because of rapid runoff
of blood into the ventricle. Aortic regurgitation is associated with a longer ventricular ejection phase.
11. Angina caused by coronary artery spasm is called angina.
a. stable
b. classic
c. unstable
d. Prinzmetal variant
ANS: D
Variant, or Prinzmetal, angina is the term applied to vasospasm-initiated anginal symptoms caused by
significant atherosclerotic plaques. These spasms usually respond promptly to vasodilating agents.
Coronary artery spasm does not produce stable angina. Classic or typical angina is often associated with
physical exertion. Unstable angina presents a similar clinical picture as myocardial infarction.
12. While hospitalized, an elderly patient with a history of myocardial infarction was noted to have
high levels of low-density lipoproteins (LDLs). What is the significance of this finding?
a. Increased LDL levels are associated with increased risk of coronary artery disease.
b. Measures to decrease LDL levels in the elderly would be unlikely to affect the progression of this
disease.
c. Increased LDL levels are indicative of moderate alcohol intake, and patients should be advised to
abstain.
d. Elevated LDL levels are an expected finding in the elderly and therefore are not particularly
significant.
ANS: A
High levels of low-density lipoproteins (LDLs), which are high in cholesterol, have been associated with
the highest risk of coronary atherosclerosis. Even when lipid metabolism is normal, a high-fat diet can
overwhelm the liver’s ability to clear LDL cholesterol from the circulation and result in hyperlipidemia.
Dietary fat restriction may be beneficial in reducing cholesterol in this case. Increased LDL levels are not
indicative of alcohol intake. Elevated
LDL levels are not an expected finding in the elderly and should be treated.
13. What compensatory sign would be expected during periods of physical exertion in a patient with
limited ventricular stroke volume?
a. Hypotension
b. Bradycardia
c. Aortic regurgitation
d. Tachycardia ANS: D
An individual with reduced stroke volume would exhibit compensatory increases in heart rate.
Hypertension is associated with decreased ventricular stroke volume. An individual with reduced stroke
volume would exhibit compensatory increases in heart rate; therefore, bradycardia would not be
expected. Aortic regurgitation would not be an expected compensatory sign of limited stroke volume.
14. An elderly patient’s blood pressure is measured at 160/98. How would the patient’s left
ventricular function be affected by this level of blood pressure?
a. This is an expected blood pressure in the elderly and has little effect on left ventricular function.
b. Left ventricular workload is increased with high afterload.
c. High blood pressure enhances left ventricular perfusion during systole.
d. High-pressure workload leads to left ventricular atrophy. ANS: B
Activation of the sympathetic nervous system increases the heart rate, contractility, blood pressure, and
fluid retention by the kidney. Unfortunately, these compensatory efforts impose a greater workload on
the heart. A blood pressure of 160/90 mm Hg is a higher than expected blood pressure in an elderly
patient. High blood pressure does not enhance ventricular perfusion. Greater workload on the heart
may contribute to further ischemic damage.
15. A patient with a history of myocardial infarction continues to complain of intermittent chest
pain brought on by exertion and relieved by rest. The likely cause of this pain is
a. stable angina.
b. myocardial infarction.
c. coronary vasospasm.
d. unstable angina.
ANS: A
Stable angina is the most common form of chest pain and is characterized by pain that is caused under
conditions of increased myocardial workload, such as physical exertion or emotional strain. Pain related
to myocardial infarction is not relieved by rest. Coronary vasospasm is characterized by unpredictable
attacks of angina pain. A patient with unstable angina presents with symptoms similar to myocardial
infarction.
16. The majority of cardiac cells that die after myocardial infarction do so because of
a. cell rupture.
b. insufficient glucose.
c. thrombus.
d. apoptosis.
ANS: D
MI results when prolonged or total disruption of blood flow to the myocardium causes cellular death by
necrosis or apoptosis. Cardiac cells do not die as a result of cellular rupture.
Insufficient glucose is not associated with myocardial death. The initiating event of MI is believed to be
related to thrombus, but the resulting disruption of flow to the myocardium is because of necrosis or
apoptosis.
17. Which serum biomarker(s) are indicative of irreversible damage to myocardial cells?
a. Elevated CK-MB, troponin I, and troponin T
b. Markedly decreased CK-MB and troponin I
c. Elevated LDL
d. Prolonged coagulation time ANS: A
Elevated cardiac biomarkers are one indication of myocardial necrosis. Cardiac biomarkers may not be
utilized if a patient presents with chest pain and evidence of acute ischemia on the electrocardiogram.
Cardiac biomarkers are elevated in the presence of MI. Elevated LDL is a risk factor for coronary
atherosclerosis. Coagulation times are not used to assess myocardial damage.
18. A loud pansystolic murmur that radiates to the axilla is most likely a result of
a. aortic regurgitation.
b. aortic stenosis.
c. mitral regurgitation.
d. mitral stenosis.
ANS: C
The murmur of mitral regurgitation usually occurs throughout ventricular systole (pansystolic), radiates
toward the left axilla, and has a high-pitched blowing character. Aortic insufficiency is characterized by a
high-pitched blowing murmur during ventricular diastole. A characteristic murmur of aortic stenosis
occurs during ventricular systole and varies in intensity, progressively getting louder and then
diminishing (crescendo-decrescendo). The murmur of aortic stenosis generally radiates to the neck.
Blood rushing through the narrowed mitral valve during ventricular diastole can sometimes be heard as
a low-pitched, rumbling diastolic murmur at the heart’s apex.
19. A patient with significant aortic stenosis is likely to
a. syncope.
b. hypertension.
c. increased pulse pressure.
d. peripheral edema.
ANS: A
In the patient with aortic stenosis, syncope and “greying out” episodes may occur when cerebral
perfusion is inadequate. Low systolic blood pressure is a common sign of aortic stenosis. Faint pulses are
a common sign of aortic stenosis. Peripheral edema is not associated with aortic stenosis.
20. Myocarditis should be suspected in a patient who presents with
a. chest pain and ST elevation.
b. acute onset of left ventricular dysfunction.
c. murmur and abnormal valves on echocardiogram.
d. family history of cardiomyopathy. ANS: B
Acute myocarditis is commonly characterized by left ventricular dysfunction or general dilation of all
four heart chambers. Chest pain and ST elevation is indicative of myocardial infarction. Myocarditis is
associated with viral infections. Dilated cardiomyopathy runs in families and has a genetic basis.
21. Atherosclerotic plaques with large lipid cores are prone to
a. dislodgement.
b. binding.
c. rupture.
d. attachment.
ANS: C
Rupture of atherosclerotic plaques with large lipid cores initiates [Show Less]