congenital heart defect
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)
Exercise stress testing
Question 7.7.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)
Coarctation of the aorta
An adrenocortical disorder
Question 8.8.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)
Acute arterial occlusion that will be treated with angioplasty
Raynaud disease that will require antiplatelet medications
Atherosclerotic occlusive disease necessitating thrombolytic therapy
Giant cell temporal arteritis that will be treated with corticosteroids
Question 9.9.A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his nurse practitioner. Which of the following aspects of hyperlipidemia would the nurse practitioner most likely take into account when teaching the patient? (Points : 0.4)
Hyperlipidemia is a consequence of diet and lifestyle rather than genetics.
HDL cholesterol is often characterized as being beneficial to health.
Cholesterol is a metabolic waste product that the liver is responsible for clearing.
The goal of medical treatment is to eliminate cholesterol from the vascular system.
Question 10.10.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)
Resolution of compensatory pulmonary edema and heart arrhythmias
Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility
Infusion of normal saline of Ringer lactate to maintain the vascular space
Administration of oxygen and epinephrine to promote perfusion
Question 11.11.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)
Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias
Ventricular arrhythmia as a result of alternating vagal and sympathetic stimulation
Torsades de pointes as a result of disease of the bundle of His
Premature atrial contractions that vacillate between tachycardic and bradycardic episodes as a consequence of an infectious process
Question 12.12.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)
The patient’s juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation.
Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system.
Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction.
The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.
Question 13.13.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)
Impaired physical restraint of the left ventricule
Increased friction during the contraction/relaxation cycle
Reduced protection from infectious organisms
Impaired regulation of myocardial contraction
Question 14.14.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)
Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest.
Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.
Peripheral dilation is associated with decreased stroke volume and ejection fraction.
Heart valves are not capable of preventing backflow in cases of atrial congestion.
Question 15.15.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)
Plasma angiotensin I and II and renin
Urinary sodium and potassium
Platelet count, serum creatinine, and liver enzymes
Urinary catecholamines and metabolites