Download Nursing Quiz Sample - Jennifer A. Norman

Cardiovascular Quiz Questions
1. An African-American patient of yours has been taking lisinopril (Prinivil®) for hypertension. Which of
the following pharmacological treatments would better optimize the patient’s response?
a. Beta-blocker
b. Direct-acting vasodilator
*c. Thiazide diuretic
d. Angiotensin-converting enzyme inhibitor
Correct Feedback: Correct! A thiazide diuretic combined with an ace inhibitor will be more therapeutic
for an African-American patient with hypertension.
2. Which of the following is a characteristic of diastolic murmurs?
a. They are always accompanied by an S3 heart sound.
b. They are most commonly functional, or innocent, murmurs.
c. They begin with the onset of the S1 heart sound and terminate with or before the S2 heart sound.
*d. They begin with the onset of the S2 heart sound and terminate with or before the S1 heart sound.
Correct Feedback: Correct! Early diastolic murmurs start at the same time as S2 with the close of the
semilunar (aortic and pulmonary) valves and typically end before S1. Common causes include aortic or
pulmonary regurgitation and left anterior descending artery stenosis. Mid-diastolic murmurs start after
S2 and end before S1 due to turbulent flow across the atrioventricular (mitral and tricuspid) valves
during the rapid filling phase from mitral or tricuspid stenosis. Late diastolic (presystolic) murmurs start
after S2 and extend to S1, and they have a crescendo configuration. Late diastolic (presystolic) murmurs
can be associated with AV valve narrowing, and they include mitral stenosis, tricuspid stenosis, myxoma,
and complete heart block.
3. A Chinese male patient, 55, has a follow-up appointment after cardiac bypass surgery. The patient
brings his father with him into the examination room. Which nurse practitioner action demonstrates
culturally sensitive care?
*a. Asking the patient's father whether he has any questions regarding his son's care
b. Asking the patient's father to leave the room due to confidentiality issues
c. Performing the examination without commenting to the patient's father
d. Performing the examination, then telling the patient's father the examination findings
Correct Feedback: Correct! The Chinese culture emphasizes loyalty to family and devotion to traditions
and puts less emphasis on individual feelings. Assess your patient’s kinship relationships and determine
which family members are most influential in decision-making. When possible, engage the whole family
in discussions that involve decisions and education about care. Be aware of the importance of family
members serving in caregiver roles. Ask your patient which family members they want included in
medical decisions.
4. Which drug is most likely to increase lipoprotein levels?
a. Furosemide (Lasix®)
*b. Hydrochlorothiazide (HCTZ)
c. Spironolactone (Aldactone®)
d. Triamterene (Dyrenium®)
Correct Feedback: Correct! High doses—50 milligrams or more—of some diuretics, such as
hydrochlorothiazide, can temporarily increase your low-density lipoprotein (LDL, or "bad") cholesterol
and triglycerides. However, this spike usually returns to normal within a year of starting these
medications.
5. Which of the following heart sounds is abnormal in an adult?
a. Split S2
b. S1
*c. S3
d. S2
6. A 73-year-old man with long-standing hypertension and a history of myocardial infarction 5 years ago
presents with worsening shortness of breath with exertion over the past 3 months. He says he sleeps on
two pillows at night, or he sleeps in his recliner. He has a chronic cough and increasing fatigue. An exam
reveals an S3 and coarse rales bilaterally in the lung bases. He becomes short of breath while describing
his symptoms. Which type of heart failure is most consistent with these signs and symptoms?
a. Stage B left ventricular
b. Stage B right ventricular
c. Stage D right ventricular
*d. Stage C left ventricular
Correct Feedback: Correct! This is an example of a patient with stage C left ventricular heart failure. The
American College of Cardiology (ACC) and American Heart Association (AHA) have developed a
classification of heart failure based on stages of the syndrome (Table 1).4 Stage A includes patients who
are at risk for developing heart failure but who do not have structural heart disease currently. The
management strategy in this group is prevention of heart failure. Stage B includes patients with
structural heart disease but no symptoms. The management goal is prevention of LV remodeling leading
to heart failure. Stage C includes patients with structural heart disease with current or prior
symptomatic heart failure. Diuretics, digoxin, and aldosterone antagonists may be added to angiotensinconverting enzyme (ACE) inhibitors and beta-blockers, depending on the severity of symptoms. Cardiac
resynchronization therapy also may be considered. Stage D includes patients with severe refractory
heart failure, and physicians should consider either end-of-life care or high-technology therapies, such
as cardiac transplantation or mechanical circulatory support.
7. Which finding is consistent with target-organ damage in hypertension?
a. Edema of extremities
*b. Left ventricular hypertrophy
c. DTR 5+
d. Thyromegaly
Correct Feedback: Correct! Left ventricular hypertrophy develops in response to some factor, such as
high blood pressure, that requires the left ventricle to work harder. As the workload increases, the walls
of the chamber grow thicker, lose elasticity, and eventually may fail to pump with as much force as that
of a healthy heart.
8. Cardiac findings associated with heart failure include the following EXCEPT:
a. S3 presence
b. Mitral regurgitation murmur
c. Laterally displaced PMI
*d. Split S1
Correct Feedback: Correct! A split S1 in an otherwise healthy adult is no cause for concern.
The presence of an S3, a mitral regurgitation, or a laterally displaced PMI indicates heart failure.
9. Which of the following would cause the NP to order a cardiology workup for a 37-year-old male
patient who wants to start exercising?
*a. Sudden cardiac death of father at age 41
b. Smoking 1 pack per day for 18 years
c. History of hypertension
d. Family history of heart failure
Correct Feedback: Correct! A cardiology workup is prudent if the patient reports his father had a sudden
cardiac death before the age of 55.
10. Which of the following presentations is NOT consistent with an aortic dissection?
a. Sudden-onset severe and tearing chest pain
b. Blood pressure and pulse pressure differences between the upper or lower extremities
c. Enlargement of the aortic arch
*d. Substernal pressure provoked by exertion
Correct Feedback: Correct! Substernal pressure provoked by exertion is a classic sign of angina pectoris.
A sudden onset of severe and tearing chest pain, blood pressure and pulse pressure differences
between the upper or lower extremities, and hypertrophy of the aortic arch are all signs and symptoms
of an aortic dissection. Tearing or ripping pain in the intrascapular area may indicate that the dissection
involves the descending aorta. The pain typically changes as the dissection evolves. Aortic dissection can
be presumed in patients with symptoms and signs suggestive of myocardial infarction but without
classic electrocardiographic (ECG) findings.