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)
The child is experiencing a reentry rhythm in his right atrium.
The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions.
The child is likely to have a normal ECG apart from the rapid heart rate.
The boy’s atria are experiencing abnormal sympathetic stimulation.
Question 17.17.A 66-year-old obese man with a diagnosis of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction. Which of the following assessment findings is inconsistent with his diagnosis? (Points : 0.4)
His resting blood pressure is normally in the range of 150/90 and an echocardiogram indicates his ejection fraction is 30%.
His end-diastolic volume is higher than normal and his resting heart rate is regular and 82 beats per minute.
He is presently volume overloaded following several days of intravenous fluid replacement.
Ventricular dilation and wall tension are significantly lower than normal.
Question 18.18.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)
“Your blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation.”
“Only around one quarter of your blood is in your heart at any given time.”
“Blood pressure and blood volume roughly mimic one another at any given location in the circulatory system.”
“Left-sided and right-sided pumping action at each beat of the heart must equal each other to ensure adequate blood distribution.”
Question 19.19.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)
“Remember, the ‘H’ in HDL and the ‘L’ in LDL correspond to high danger and low danger to your health.”
“Having high cholesterol increases your risk of developing diabetes and irregular heart rate.”
“Smoking and being overweight increases your risk of primary hypercholesterolemia.”
“Your family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk.”
Question 20.20.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)
Mitral valve regurgitation
Aortic valve stenosis
Mitral valve stenosis
Aortic valve regurgitation
Question 21.21.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)
A 61-year-old man whose ECG was characterized by widespread T wave inversions on admission but whose T waves have recently normalized
A 77-year-old with diminished S3 and S4 sounds, an irregular heart rate, and a history of atrial fibrillation
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
A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels
Question 22.22.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)
The man’s blood work indicates polycythemia (elevated red cells levels) and leukocytosis (elevated white cells).
The man’s blood pressure is 178/102 and he has abnormal liver function tests.
The man is acutely short of breath and his oxygen saturation is 87%.
The man’s temperature is 101.9°F and he is diaphoretic (heavily sweating).
Question 23.23.As part of the diagnostic workup for a male patient with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements, and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? (Points : 0.4)
Echocardiogram, PET scan, ECG
Ambulatory ECG, cardiac MRI, echocardiogram
Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy
Cardiac catheterization, cardiac CT, exercise stress testing
Question 24.24.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)
“Scarring of urethra suggestive of recurrent urinary tract infections is evident.”
“Bilateral renal hypertrophy noted.”
“Vessel wall changes suggestive of venous stasis are evident.”
“Arterial sclerosis of subcortical brain regions noted.”
Question 25.25.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)
Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation.
Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.
The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions.
The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential.