NURS 620 EXAM II (CARDIOVASCULAR AND RESPIRATORY)
QUESTIONS AND ANSWERS 2022
Sarah, who is postmenopausal, has controlled asthma and hypertension being
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effectively treated with medication, and she smokes cigarettes. She has a lowdensity lipoprotein (LDL) cholesterol level of 170 mg/dL and a high-density
lipoprotein (HDL) level of 40 mg/dL. To reduce Sarah's risk of a coronary event, the
treatment plan would focus on:
A. Lowering her LDL cholesterol level.
B. Lowering her HDL cholesterol level.
C. aggressively treating and controlling her hypertension and asthma.
D. getting Sarah to stop smoking. - ANS-A. Lowering her LDL cholesterol level.
The most common cause of elevated total and low-density lipoprotein cholesterol
levels in the United States
A. heredity
B. Hypothyroidism
C. Diabetes
D. A diet high in saturated fat. - ANS-D. A diet high in saturated fat.
Which of the following statements about hypertension is true?
A. It is frequently caused by pheochromocytoma.
B. It is usually the result of an underlying correctable problem.
C. The cause is unknown in approximately 95% of cases.
D. It has a higher incidence among adult white men than any other group. - ANS-C.
The cause is unknown in approximately 95% of cases.
What value on the ABI diagnoses PAD?
A. Less than 0.25
B. Less than 0.5
C. Less than 0.9
D. 1 or greater - ANS-D. 1 or greater.
Harry, age 54, comes to your office with waxing and waning ischemic symptoms
over a period of days and weeks, an increase in angina while at rest, and transient
ST changes on his echocardiogram. This presentation leads you to believe that he is
experiencing.
A. A brain attack (stroke/CVA).
B. A myocardial infarction.
C. Stable angina.
D. Unstable angina. - ANS-D. Unstable angina
Pharmacological therapy for mitral valve disease in adults include:
A. Treatment of dyspnea with diuretics to relieve congestion.
B. Reduction of fast ventricular rates with beta blockers or calcium channel blockers
C. Preload reduction with antihypertensive agents to decrease regurgitant flow.
D. Daily antibiotic use to ward off bacterial infections. - ANS-A. Treatment of
dypsnea with diuretics to relieve congestion.
Some older adults develop postural hypotension with hypertensive drug therapy.
What is included in your teaching with these individuals?
A. Drug therapy will be discontinued as soon as their blood pressure stabilizes to
prevent this problem from recurring.
B. Slight dehydration will prevent postural hypotension from occurring.
C. Clients should sleep in a high Fowler's position to prevent this from happening.
D. Clients should be taught to sit on the edge of the bed before standing. - ANS-D.
Clients should be taught to sit on the edge of the bed before standing.
When a client is getting ready for a cardiac catheterization, which question is
essential to ask?
A. Are you allergic to shellfish?
B. Have you ever had a catheterization before?
C. Have you completed an advance directive?
D. What current medications are you on? - ANS-A. Are you allergic to shellfish?
Which would be the last step you would consider in a client with long-term chronic
ischemic heart disease?
A. Use of ASA.
B. Use of beta-blockers, calcium channel blockers.
C. Risk factor and lifestyle modification.
D. A coronary angiogram. - ANS-D. A coronary angiogram.
When teaching a client with hypertension about restricting dietary sodium, you would
include which of the following instructions?
A. Sodium restriction can cause serious adverse effects.
B. Diets with markedly reduced intake of sodium may be associated with other
beneficial aspects beyond blood pressure control.
C. Seventy-five percent of sodium intake is derived from processed food.
D. A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable. -
ANS-C. Seventy-five percent of sodium intake is derived from processed food.
Margie, age 45, comes into your office as a new patient and says that she has been
on nicotinic acid to treat her serum hyperlipidemia for years. What do you tell her?
A. There has been no evidence to show that this works. Let's change you to a statin.
B. Boy, your old provider is antiquated.
C. If you've been on it for years, and it's working, let's just keep monitoring your
levels.
D. Let's eliminate the nicotinic acid for a few months to determine your baseline
cholesterol levels. - ANS-C. If you've been on it for years, and it's working, let's just
keep monitoring your levels.
You are managing a client with CHF. The client is presently on Carvedilol 12. 5 mg
PO BID, Lisinopril 2.5 mg PO daily, Lasix 80 mg PO daily, and spironolactone
(Aldactone) 25 mg po daily. He is in to see you for a 2-week follow-up and shares he
has gained 7 lb. in the past week. He shares he has been faithful to his fluid and
dietary restrictions and that his urinary output is somewhat less than it has been.
What medication could you add to optimize the response to the loop diuretic?
A. Bumex
B. Metoloazone
C. Demadex
D. Diamox - ANS-B. Metoloazone
Sandra says she wants to know more about the Pooled Cohort Equation to
determine her 10-year risk of ASCVD. You tell her that the variables include which of
the following?
A. Total and HDL cholesterol levels.
B. Systolic BP
C. Diabetes.
D. Current smoking status.
E. All of the above. - ANS-E. All of the above.
Martha, age 36, presents with a complaint of increasing shortness of breath and
fatigue over the past 6 months. She has been trying to lose weight, has been on a
walking exercise program for over a year, and had taken the fenfluraminephentermine (Fen-Phen) combination many years ago but stopped when its adverse
effects were reported. You examination reveals a grade II/VII systolic murmur along
the apex. What do you do?
A. Obtain pulmonary function tests.
B. Instruct the client about other exercise activities that may not produce her
symptoms.
C. Refer the client to a cardiologist for an echocardiogram and cardiovascular workup.
D. Start endocarditis prophylaxis. - ANS-C. Refer the client to a cardiologist for an
echocardiogram and cardiovascular work-up.
Which statement about mitral valve prolapse (MVP) is true?
A. MVP occurs in about 10% of the population.
B. MVP is usually detected in older adults.
C. The incidence is equal in men and women younger than age 20.
D. The incidence is more common in women younger than age 20. - ANS-D. The
incidence is more common in women younger than age 20.
Selma, age 76, has acute peripheral arterial occlusion of a lower extremity. Before
you begin your examination, you know that it:
A. May present with only complaints of coldness or paresthesia of the extremity.
B. May present as the only disease.
C. Always occurs in the lower extremities.
D. Will result in an extremity that appears blue. - ANS-A. May present with only
complaints of coldness or paresthesia of the extremity.
JNC 8 recommends four classifications of HTN drugs to be used for initial therapy of
adult hypertension. Which of the following classifications is NOT recommended to
begin therapy with?
A. Thiazide-type diuretics
B. Calcium Channel blockers
C. Angiotensin-converting enzyme inhibitors
D. Beta blockers - ANS-D. Beta blockers
What is the most important question to ask when a patient presents with chest pain?
A. What were you doing at the time of onset of chest pain?
B. What was the time of the onset of pain?
C. Are you a smoker?
D. When was the last time you had bloodwork done? - ANS-B. What was the time of
onset of pain?
Which of the following statements about aortic stenosis is true?
A. The disease typically manifests during midlife.
B. Once symptoms appear, life expectancy without surgery is about 10 years.
C. Right from the early course of disease, symptoms are bothersome.
D. The cardinal symptoms include dypsnea, angina, and syncope. - ANS-D. The
cardinal symptoms include dypsnea, angina, and syncope.
Terry, a 42 year-old black man who just moved into the area, comes into the clinic
for a new client visit. He brings his medical records from his previous health-care
provider; the records show a blood pressure of 140/104 mm Hg on two separate
occasions. Recent laboratory tests (CBC, chemistry profile, urinalysis, and TSH) -
ANSBob is being seen in the office, and you suspect and acute ischemic syndrome and
an acute myocardial infarction. Which would be the LAST step that you would
consider?
A. Prompt admission to a monitored bed with cardiology consultation.
B. Initiation of aspirin, intravenous heparin, and anti-ischemic therapy with nitrates or
beta blockers.
C. Measurement of serum lipid levels to determine risk factors of hyperlipidemia.
D. Evaluation for possible angiography with rescue percutaneous transluminal
coronary angioplasty or thrombolytic therapy. - ANS-C. Measurement of serum lipid
levels to determine risk factors of hyperlipidemia.
Jessica is pregnant and is being seen for the first time. She states that her BP has
been high for a long time, but she never wanted to take medication for it. Today, her
BP is 172/98, her lungs are clear, and she has no pedal or ankle edema. What
medication would you likely order?
A. Methyldopa
B. Atenolol
C. Nifedipine
D. Clonidine - ANS-A. Methyldopa, an alpha-adrenergic inhibitor, is used to treat
chronic hypertension during pregnancy. At low doses it can be used as
monotherapy. Category B pregnancy drug
Which of the following antihypertensive agents would most likely produce a rebound
hypertensive crisis following its abrupt withdrawal?
A. Doxazosin
B. Lisinopril
C. Losartan
D. Clonidine - ANS-D. Clonidine
Harry has been on HTN therapy with a single agent for 1 month. His readings are
still too high. What do you tell him?
A. Let's give it a 3 month trial. If your blood pressure is still too high after that, we'll
make some changes.
B. You must continue to follow the DASH diet, which will make a difference.
C. You must exercise for at least 30 minutes on most days of the week.
D. We must increase the dosage of that drug now or add a second drug. - ANS-D.
We must increase the dosage of that drug now or add a second drug.
Jamie, age 49, who has a history of hyperlipidemia, has symptoms that lead you to
suspect unstable angina. Her ECG shows some changes. Your next action would be
to:
A. Start aspirin therapy and schedule an exercise stress test at the client's
convenience.
B. Initiate lipid-lowering agents.
C. hospitalize the client in a monitored setting with pharmacological control of
ischemia, and thrombosis appropriate.
D. prescribe a holter monitor and start her on a beta blocker. - ANS-C. hospitalize
the client in a monitored setting with pharmacological control of ischemia, and
thrombosis appropriate.
Josie is 78. she has no existing problems and is wondering what her systolic BP
should be. You tell her that:
A. less than 120
B. less than 130
C. Less than 140
D. Less than 150 - ANS-D. less than 150
George, a 59 year old African American man, has just been diagnosed with HTN.
which of the following classifications of medications would you start him on?
A. ACE inhibitor with a thiazide-type diuretic.
B. ARB with a thizaide-type diuretic.
C. Calcium channel blocker with a thiazide diuretic
D. Beta blocker with a thiazide-type diuretic. - ANS-C. Calcium channel blocker with
a thiazide diuretic.
Which of the following is usually indicative of an abdominal aortic aneurysm?
A. RUQ tenderness
B. Venous hum in abdomen
C. Ascites
D. Positive bruit or wide, diffuse pulsation in epigastric area. - ANS-D. Positive bruit
or wide, diffuse pulsation in epigastric area.
Many of the clients with mitral valve prolapse exhibit:
A. A slow heart rate.
B. somnolence
C. A lengthened PR interval on ECG
D. fatigue - ANS-D. Fatigue
Which of the following usually indicates hyperlipidemia in an adult?
A. Lipoma
B. Xanthelasma
C. Jaundiced skin
D. Multiple actinic keratoses - ANS-B. Xanthelasma
During a cardiovascular assessment, why is it important to note fundoscopic
changes?
A. You may pick up beginning cataracts in this age group.
B. You should note any glaucoma because some medications will be
contraindicated.
C. Changes may suggest the possibility of target organ involvement.
D. You may be able to pick up arcus senilis. - ANS-C. Changes may suggest the
possibility of target organ involvement.
Martin, age 56, has hypertension and has been taking antihypertensive medication
for about 10 years. He has been very stable. You have not seen him in about 6
months. His examination today should specifically:
A. Include only a blood pressure measurement with the client seated comfortably.
B. Include a fundoscopic examination.
C. Be a focused examination limited to the respiratory and cardiovascular systems.
D. Include a discussion of weaning him off his medications. - ANS-B. Include a
fundoscopic examination.
Jeremiah has been on lipid-lowering therapy (statins) for 2 years. He is new to your
practice. He says, "I haven't had my liver function tests in a while to check if my
cholesterol medication is causing a problem." What do you tell him?
A. "You've been tolerating the medication well--we no longer need to monitor this"
B. "Oh, yes, we check liver function tests every 6 months when you're on statins"
C. "We'll order LFTs before your next visit"
D. "We better stop your medication until we get the results" - ANS-A. "You've been
tolerating the medication well--we no longer need to monitor this"
Janice, age 64, arrives at the office this morning without an appointment. She
appears quite anxious and pale and is complaining of an intermittent aching across
her sternum and into her jaw and left arm that started about an hour ago and woke
her out of a sound sleep. She took an antacid and acetaminophen, but they did not
seem to help. her blood pressure is 160/90 and heart rate was 98. An
electrocardiogram shows normal sinus rhythm with 2-mm ST segment elevations in
leads II, III, and AVF. What do you suspect?
A. An acute anterior wall myocardial infarction.
B. An acute inferior wall MI.
C. Severe gastrointestinal reflux.
D. An anxiety attack. - ANS-B. An acute inferior wall MI
An anterior wall MI most likely occurs from occlusion of the:
A. Left circumflex artery.
B. Left main artery.
C. Right coronary artery.
D. Left anterior descending artery. - ANS-D. Left anterior descending artery
The classic 12-lead electrocardiogram change that indicates an acute coronary
syndrome is:
A. ST-segment elevation.
B. T wave inversion
C. Flipped P waves with a prolonged PR interval.
D. Deep Q waves. - ANS-A. ST-segment elevation.
Which of the following drugs should be considered as first-line therapy for a client
with HTN and heart failure?
A. Enalapril
B. Diltiazem
C. Atenolol
D. Metoprolol - ANS-A. Enalapril
An active 68-year old man under your care has known acquired valvular aortic
stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He
has recently been told he needs elective replacement of his aortic valve. When he
comes in, you discover that he has about 10 remaining teeth in poor repair. Your
recommendation would be to:
A. Defer any further dental work until his valve replacement is completed.
B. Instruct the client to have dental extraction done cautiously, having no more than
two teeth per visit removed.
C. Suggest that he consult with his oral surgeon about removing all the teeth at once
and receiving appropriate antibiotic prophylaxis.
D. Coordinate with his cardiac and oral surgeons to have the tooth extraction and
valve replacement done at the same time to reduce the risk of anesthetic
complications. - ANS-C. Suggest that he consult with his oral surgeon about
removing all the teeth at once and receiving appropriate antibiotic prophylaxis.
To determine the presence of target organ damage (TOD) and other risk factors in
the client with hypertension, basic diagnostic tests that should be ordered include:
A. CXR, ECG, UA, CBC, Chem profile, lipid profile, and TSH level.
B. Renal arteriogram
C. Plasma renin activity and a 24 hour urinary sodium.
D. Echocardiogram. - ANS-A. CXR, ECG, UA, CBC, Chem profile, lipid profile, and
TSH level.
To reduce the incidence of coronary events in an individual without coronary artery
disease who has two or more risk factors, the goal serum LDL should be:
A. 170-190 mg/dL.
B. 150-170 mg/dL.
C. 130-150 mg/dL.
D. less than 130 mg/dL. - ANS-C. 130-150 mg/dL.
Murmurs are graded according to their intensity (loudness). A murmur that is audible
with the stethoscope off the chest is a:
A. Grade III murmur.
B. Grade IV murmur.
C. Grade V murmur
D. Grade VI murmur. - ANS-D. Grade VI murmur.
Charles has chronic ischemic heart disease and is taking a beta-blocker, which
results in:
A. An increase in high-density lipoprotein cholesterol.
B. A reduced heart rate.
C. A decreased diastolic filling time.
D. An increase in oxygen demand. - ANS-B. A reduced heart rate.
Which of the following statements is true concerning auscultation of the typical
murmur associated with aortic stenosis?
A. It is a harsh, crescendo-decrescendo ejection type that often radiates to the
carotid arteries.
B. It is a diastolic murmur.
C. It is best heard at the apex of the heart.
D. The loudness of the murmur reflects the severity of the lesion. - ANS-A. It is a
harsh, crescendo-decrescendo ejection type that often radiates to the carotid
arteries.
When auscultating an adult client's heart, you note a short, high frequency click
(opening snap) after S2 during the beginning of diastole. What could this indicate?
A. Aortic regurgitation.
B. Mitral stenosis.
C. Mitral regurgitation.
D. Nothing. this is normal. - ANS-B. Mitral stenosis.
Which resuscitation recommendation made by the American Heart Association has
the highest priority?
A. Timely delivery of an epinephrine bolus.
B. Rapid provision of advanced airway management.
C. High quality, uninterrupted chest compression.
D. Early electrical therapy. - ANS-C. High quality, uninterrupted chest compression.
Deep vein thrombosis (DVT) may result in:
A. generalized edema of the involved extremity.
B. atrophy of leg muscles.
C. loss of sensation in the affected extremity.
D. The release of fat emboli. - ANS-A. Generalized edema of the involved extremity.
Sheila, age 78, presents with a chief complaint of waking up during the night
coughing. You examine her and find an S3 heart sound, pulmonary crackles (rales)
that do not clear with coughing, and peripheral edema. What do you suspect?
A. Asthma
B. Nocturnal allergies.
C. Heart failure.
D. Valvular disease. - ANS-C. Heart failure.
Rona, age 69, has hypertension, drinks one glass of white wine per day, and is
slightly overweight. She asks you if making changes in her life at this age will make
any difference. you tell her that lifestyle modifications for the control of HTN:
A. Are not as effective in older adults because HTN is an inevitable consequence of
aging.
B. Require a marked reduction in weight and a very limited choice of foods to
achieve any benefit.
C. Should include at least three glasses of red wine every day because it improves
HDL levels, a known cardiovascular risk factor, which may be worsened by HTN.
D. May prevent HTN, lower elevated blood pressure, and reduce the number and
dosage of antihypertensive medications needed to manage a condition. - ANS-D.
May prevent HTN, lower elevated blood pressure, and reduce the number and
dosage of antihypertensive medications needed to manage a condition.
Nathan, age 63, comes in for his annual physical. He has a history of mild
hypertension and hyperlipidemia that he has not been successful in treating by diet
and weight loss. His only complaint is a problem with impotence. On physical
examination, you note a palpable, pulsatile abdominal mass in the umbilical region; a
bruit above the umbilical region; and diminished femoral pulses. You suspect:
A. Renal artery stenosis.
B. AAA
C. A cardiac tumor
D. A thoracic aortic aneurysm. - ANS-B. Abdominal Aortic Aneurysm
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