Chapter 24: Alterations of Cardiovascular Function

Power-Kean et al: Huether and McCance's Understanding Pathophysiology, Second

Canadian Edition

MULTIPLE CHOICE

1. A 75-year-old obese patient with female genitalia presents to the primary care provider
reporting edema in the lower extremities. Physical examination reveals that the patient has
varicose veins and chronic venous insufficiency. Upon performing the history, which of the
following is a possible cause for the varicose veins?
a. Extreme exercise
b. Long periods of standing
c. Trauma to the deep veins
d. Ischemia
ANS: B
The probable cause of the patient’s varicose veins is gradual venous distension caused by the
action of gravity on blood in the legs due to long periods of standing. Varicose veins are most
likely due to long periods of standing leading to the action of gravity promoting venous
distension. Exercise would help prevent this. Trauma can occur, but usually this affects the
more superficial veins. Ischemia affects arteries, not veins.

DIF: Cognitive Level: Analyze REF: Varicose Veins and Chronic Venous Insufficiency
TOP: Physiological Integrity

2. A 52-year-old patient with male genitalia presents with pooling of blood in the veins of the
lower extremities and edema. The diagnosis is chronic venous insufficiency. What is an
expected assessment finding of this disorder?
a. Deep vein thrombus formation
b. Skin hyperpigmentation
c. Gangrene
d. Edema above the knee
ANS: B
Symptoms include edema of the lower extremities and hyperpigmentation of the skin of the
feet and ankles but deep vein thrombi do not form. Edema in these areas may extend to the
knees but not above. Gangrene does not occur in veins but in arteries.

DIF: Cognitive Level: Analyze REF: Varicose Veins and Chronic Venous Insufficiency
TOP: Physiological Integrity

3. Superior vena cava syndrome (SVCS), causing venous distension in the upper extremities, is a
result of progressive superior vena cava:
a. inflammation.
b. occlusion.
c. distension.
d. sclerosis.
ANS: B
 SVCS is a progressive occlusion of the SVC that leads to venous distension in the upper
extremities and head. This distension is not a result of progressive inflammation, distension,
or sclerosis.

DIF: Cognitive Level: Understand REF: Superior Vena Cava Syndrome

TOP: Physiological Integrity

4. A 50-year-old patient with male genitalia with a 30-year history of smoking was diagnosed
with bronchogenic cancer. The patient developed edema and venous distension in the upper
extremities and face. Which of the following diagnosis will the nurse observe on the chart?
a. Thromboembolism
b. Deep vein thrombosis
c. Superior vena cava syndrome (SVCS)
d. Chronic venous insufficiency
ANS: C
SVCS is a progressive occlusion of the superior vena cava that leads to venous distension in
the upper extremities and head. Thromboembolism would not lead to the generalized
symptoms described in the patient. Deep vein thrombosis would not lead to upper extremity
symptoms. Chronic venous insufficiency would primarily affect one extremity.

DIF: Cognitive Level: Analyze REF: Superior Vena Cava Syndrome

TOP: Physiological Integrity

5. When a patient is diagnosed with coronary artery disease, what condition should the nurse
also consider?
a. Myocardial hypertrophy
b. Myocardial ischemia
c. Cardiac necrosis
d. Systemic inflammation
ANS: B
Coronary artery disease leads to myocardial ischemia. Coronary artery disease would not lead
to hypertrophy, necrosis, or systemic inflammation.

DIF: Cognitive Level: Understand REF: Table 24.2 TOP: Physiological Integrity

6. A nurse takes an adult patient’s blood pressure and determines it to be normal. What reading
did the nurse obtain?
a. Systolic pressure between 140 and 150 mm Hg
b. Systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg
c. Systolic pressure less than 100 mm Hg regardless of diastolic pressure
d. Systolic pressure greater than 140 mm Hg and a diastolic pressure of 100 mm Hg
ANS: B
Normal blood pressure has a systolic pressure less than 120 mm Hg and diastolic pressure less
than 80 mm Hg. A systolic pressure of 140 mm Hg or more would indicate stage I
hypertension. A systolic pressure of less than 100 mm Hg would indicate low blood pressure.
A diastolic pressure greater than 90 mm Hg would indicate hypertension.

DIF: Cognitive Level: Understand REF: Table 24.1 TOP: Physiological Integrity
 7. Most cases of combined systolic and diastolic hypertension have no known cause and are
documented on the chart as _____ hypertension.
a. primary
b. secondary
c. congenital
d. acquired
ANS: A
Most cases of hypertension are diagnosed as primary hypertension, not secondary, which is
due to a known cause. Most cases of hypertension are not a result of congenital or acquired
causes.

DIF: Cognitive Level: Understand REF: Hypertension

TOP: Physiological Integrity

8. A 30-year-old white patient with female genitalia was recently diagnosed with primary
hypertension. She reports that she eats fairly well, and has a moderate red meat consumption.
She also reports that her father and grandmother have hypertension. A nurse determines which
of the following risk factors is most likely associated with this diagnosis?
a. Ethnicity
b. Diet
c. Age
d. Family history
ANS: D
A family history of hypertension can be a risk factor for the development of the disease.
Ethnicity and diet may be factors, but less significant than her family history. Age is a factor,
but not in this case; since the patient is 30, genetics is a greater factor.

DIF: Cognitive Level: Understand REF: Hypertension

TOP: Physiological Integrity

9. A 52-year-old is diagnosed with primary hypertension but has no other health problems. What
might be the first consideration for managing the condition?
a. A beta-adrenergic agonist
b. An alpha-adrenergic agonist
c. A recommendation to reduce sodium intake
d. A calcium channel agonist
ANS: C
Hypertension Canada recommends starting with lifestyle changes when treating hypertension.
Reducing salt intake has significant effects on lowering blood pressure. A beta-adrenergic, an
alpha-adrenergic, or a calcium channel agonist drug would be used for patients with other
concurrent health problems.

DIF: Cognitive Level: Understand REF: Superior Vena Cava Syndrome

TOP: Physiological Integrity

10. When a nurse checks the patient for orthostatic hypotension, what activity did the nurse have
the patient engage in?
a. Physical exertion
b. Eating
 c. Standing up
d. Lying down
ANS: C
Orthostatic hypotension refers to a drop in blood pressure when standing up, not a drop with
exertion, eating, or lying down.

DIF: Cognitive Level: Understand REF: Orthostatic (Postural) Hypotension

TOP: Physiological Integrity

11. A patient is diagnosed with orthostatic hypotension. Which of the following symptoms would
most likely be reported?
a. Headache and blurred vision
b. Nausea and vomiting
c. Chest pain and palpitations
d. Syncope and fainting
ANS: D
Orthostatic hypotension is often accompanied by dizziness, blurring or loss of vision, and
syncope or fainting, not by headache or blurred vision, which are symptoms of hypertension.
Chest pain and palpitations may be symptomatic of myocardial infarction. Nausea and
vomiting are associated with gastrointestinal issues.

DIF: Cognitive Level: Understand REF: Orthostatic (Postural) Hypotension

TOP: Physiological Integrity

12. A patient presents to the emergency department reporting difficulty swallowing and shortness
of breath. A CT scan would most likely reveal an aneurysm in the:
a. cerebral vessels.
b. renal arteries.
c. inferior vena cava.
d. thoracic aorta.
ANS: D
Thoracic aortic aneurysms can cause dysphagia (difficulty swallowing) and dyspnea
(breathlessness). Aneurysms in cerebral vessels will produce a headache. Aneurysms in the
renal arteries will produce flank pain. Aneurysms in the inferior vena cava may produce chest
pain.

DIF: Cognitive Level: Analyze REF: Aneurysm TOP: Physiological Integrity

13. An older person is diagnosed with cerebral aneurysm. Where does the nurse suspect the
cerebral aneurysm is located?
a. Vertebral arteries
b. Basilar artery
c. Circle of Willis
d. Carotid arteries
ANS: C
Cerebral aneurysms often occur in the circle of Willis. Such an aneurysm is not associated
with the vertebral arteries, the basilar artery, or the carotid arteries.
 DIF: Cognitive Level: Understand REF: Aneurysm TOP: Physiological Integrity

14. What term should the nurse use to document a detached blood clot?
a. Thrombus
b. Embolus
c. Thromboembolus
d. Infarction
ANS: C
A thrombus is a clot that remains attached to a vessel wall; a detached thrombus is a
thromboembolus. An embolus is a bolus of material floating in the bloodstream. An infarction
is death of tissue.

DIF: Cognitive Level: Understand REF: Table 24.3 TOP: Physiological Integrity

15. A patient presents with severe chest pain and shortness of breath and is diagnosed with
pulmonary embolism. Where did the embolism most likely originate?
a. The left ventricle
b. Systemic arteries
c. A deep vein of the leg
d. The superficial veins of the arm
ANS: C
The most likely origin of the embolism is from the deep veins of the legs. An embolism is not
likely to originate in the left ventricle, the systemic arteries, or the arms.

DIF: Cognitive Level: Understand REF: Thrombus Formation in Veins

TOP: Physiological Integrity

16. Individuals with Raynaud’s phenomenon need to be counseled to avoid which of the
following conditions?
a. Allergic reactions
b. Cold exposure
c. Hot water immersion
d. Tissue injury
ANS: B
Raynaud’s phenomenon demonstrates symptoms when extremities are exposed to cold. It is
not an allergic reaction, and it is not due to hot water immersion or tissue injury.

DIF: Cognitive Level: Understand REF: Raynaud’s Phenomenon

TOP: Physiological Integrity

17. A patient is diagnosed with coronary artery disease. Which of the following modifiable risk
factors would the nurse suggest?
a. Eating out to increase variety
b. Change living arrangements
c. Decreasing tomato juice consumption
d. Stop smoking cigarettes
ANS: D
 Cigarette smoking leads to vasoconstriction and should be the first behaviour that the patient
changes. Eating out often leads to consuming large amounts of food that is high in fat, salt,
and sugar. The living arrangement of the patient’s home would not lead to the development of
coronary artery disease. Drinking tomato juice would not lead to the development of coronary
artery disease.

DIF: Cognitive Level: Understand REF: Development of Coronary Artery Disease

TOP: Physiological Integrity

18. A patient presents to a primary care provider reporting chest pain and is diagnosed with
atherosclerosis. What is this disease caused by?
a. Arterial wall thinning and weakening
b. Abnormally dilated arteries and veins
c. An accumulation of lipid-laden macrophages within the arterial wall
d. Autonomic nervous system imbalances
ANS: C
Atherosclerosis is a form of arteriosclerosis caused by lipid-laden macrophages that collect in
the arterial wall. Affected arteries are narrowed, not dilated. Atherosclerosis
is not related to autonomic nervous system imbalances, which would lead to changes in rate or
rhythm.

DIF: Cognitive Level: Understand REF: Atherosclerosis

TOP: Physiological Integrity

19. What are foam cells?

a. Deposited adipose cells in fatty streaks
b. Injured neutrophils
c. Macrophages that have engulfed low-density lipoprotein (LDL).
d. Lipid-laden mast cells.
ANS: C
Foam cells are lipid-laden macrophages that have engulfed LDL. They are deposited in
vessels, not adipose cells. Foam cells are not injured neutrophils nor are they mast cells.

DIF: Cognitive Level: Understand REF: Atherosclerosis

TOP: Physiological Integrity

20. What is the most common cause of myocardial ischemia?

a. Idiopathic vasospasm
b. Arterial emboli from a heart valve
c. Atherosclerosis
d. Venous emboli
ANS: C
The most common cause of myocardial ischemia is atherosclerosis. Myocardial ischemia is
not caused by idiopathic vasospasms or venous emboli. Arterial emboli may cause ischemia,
but atherosclerosis is the major cause of myocardial ischemia.

DIF: Cognitive Level: Understand REF: Table 24.2 TOP: Physiological Integrity
21. A 51-year-old patient with male genitalia presents with recurrent chest pain on exertion and is
diagnosed with angina pectoris. The pain occurs when:
a. cardiac output has fallen below normal levels.
b. the myocardial oxygen supply has fallen below demand.
c. myocardial stretch has exceeded the upper limits.
d. the vagus nerve is stimulated.
ANS: B
Angina is chest pain caused by myocardial ischemia, which develops if the flow or oxygen
content of coronary blood is insufficient to meet the metabolic demands of myocardial cells.
A decrease in cardiac output would lead to general systemic symptoms, not just chest pain,
which is due to a decrease in myocardial oxygenation. Myocardial stretch does not affect
angina symptoms. When the vagus nerve is stimulated, a change in rate occurs; it does not
precipitate chest pain.

DIF: Cognitive Level: Analyze REF: Myocardial Ischemia

TOP: Physiological Integrity

22. A 62-year-old patient with male genitalia presents to his primary care provider reporting chest
pain at rest and with exertion. The patient does not have a history of coronary artery disease
and reports that the pain often occurs at night. The patient is most likely experiencing which
type of angina?
a. Unstable
b. Stable
c. Prinzmetal’s
d. Silent
ANS: C
Chest pain that occurs at rest and at night is descriptive of Prinzmetal’s angina. Unstable
angina is a form of acute coronary syndrome that results from reversible myocardial ischemia.
Stable angina is predictable and occurs with activity. Silent angina has few, if any, symptoms.

DIF: Cognitive Level: Analyze REF: Myocardial Ischemia

TOP: Physiological Integrity

23. A 51-year-old patient with male genitalia is at the health clinic for an annual physical
examination. After walking from the car to the clinic, the patient developed substernal pain.
The patient also reported discomfort in the left shoulder and the jaw, lasting 2 to 3 minutes
and then subsiding with rest. The patient indicates that this has occurred frequently over the
past few months with similar exertion. What is the patient likely experiencing?
a. Stable angina
b. Unstable angina
c. Prinzmetal’s angina
d. Myocardial infarction (MI)
ANS: A
Stable angina is associated with activity and subsides with rest. Unstable angina is a form of
acute coronary syndrome that results from reversible myocardial ischemia and occurs at rest.
Chest pain that occurs at rest and at night is descriptive of Prinzmetal’s angina. MI pain does
not subside with rest.
 DIF: Cognitive Level: Analyze REF: Myocardial Ischemia
TOP: Physiological Integrity

24. A 49-year-old patient with male genitalia presents reporting chest pain. EKG reveals ST
elevation. The patient is diagnosed with myocardial ischemia. Which of the following
interventions would be most beneficial?
a. Administer a diuretic to decrease volume.
b. Apply oxygen to increase myocardial oxygen supply.
c. Encourage exercise to increase heart rate.
d. Give an antibiotic to decrease infection.
ANS: B
Increasing the myocardial oxygen supply is indicated to treat ischemia. A decrease in fluid
volume is not appropriate. Heart rate should be decreased to decrease cardiac workload.
Antibiotics are not the most beneficial, oxygen is.

DIF: Cognitive Level: Analyze REF: Myocardial Ischemia

TOP: Physiological Integrity

25. A 68-year-old patient with male genitalia presents to the ER reporting chest pain. The patient
has a history of stable angina that now appears to be unstable. What does the patient most
likely have?
a. Mild to moderate atherosclerosis
b. Impending myocardial infarction (MI)
c. Electrical conduction problems in the heart
d. Decreased myocardial oxygen demand
ANS: B
Unstable angina is an indication of impending MI. Unstable angina could be caused by
moderate atherosclerosis, altered electrical conduction, or a decrease in myocardial oxygen,
but it is an indication of impending MI.

DIF: Cognitive Level: Analyze REF: Myocardial Ischemia

TOP: Physiological Integrity

26. A 55-year-old patient with male genitalia died of a myocardial infarction. What would
autopsy most likely reveal?
a. Embolization of plaque from the aorta
b. Decreased ventricular diastolic filling time
c. Indications of myocardial ischemia and necrosis
d. Smooth muscle dysplasia in the coronary artery
ANS: C
The autopsy would reveal cellular death and necrotic change of myocardial tissue. The cause
of death is most likely occlusion of the coronary artery, not emboli from the aorta, decreased
filling time, or dysplasia in the artery.

DIF: Cognitive Level: Analyze REF: Myocardial Ischemia

TOP: Physiological Integrity
27. A 75-year-old patient with male genitalia has severe chest pain and dials 9-1-1. Based upon
the laboratory findings indicating the patient has elevated levels of cardiac troponins I and T,
the nurse suspects which of the following has occurred?
a. Raynaud’s disease
b. Myocardial infarction (MI)
c. Orthostatic hypotension
d. Angina
ANS: B
The diagnosis of acute MI is made on the basis of serial cardiac biomarker alterations. The
cardiac troponins (troponins I and T) are the most specific indicators of MI. Elevated
troponins I and T are indicative of MI, not Raynaud’s disease, orthostatic hypotension, or
angina.

DIF: Cognitive Level: Analyze REF: Myocardial Ischemia

TOP: Physiological Integrity

28. A 28-year-old presents to the ER reporting severe chest pain that worsens with respirations or
lying down. Other signs include a fever, tachycardia, and a friction rub. Assessment findings
support which medical diagnosis?
a. Acute pericarditis
b. Myocardial infarction (MI)
c. Stable angina
d. Pericardial effusion
ANS: A
Severe chest pain that worsens with respirations or lying down in a patient with fever,
tachycardia, and a friction rub is characteristic of acute pericarditis. MI pain does not worsen
with respirations. Stable angina does not worsen with respiration or lying down. Pericardial
effusion is not manifested by these symptoms.

DIF: Cognitive Level: Analyze REF: Table 24.5 | Acute Pericarditis

TOP: Physiological Integrity

29. A 56-year-old presents to his primary care provider for a checkup. Physical examination
reveals edema, hepatomegaly, and muffled heart sounds. Which of the following is of greatest
concern to the nurse?
a. Tamponade
b. Exudate
c. Aneurysm
d. Pulsus paradoxus
ANS: A
Muffled heart sounds are an indication of tamponade, and with tamponade the blood backs up
into the venous system, leading to hepatomegaly. Muffled heart sounds with hepatomegaly
are symptoms of tamponade, not exudates. An aneurysm would present without symptoms.
Pulsus paradoxus is manifested by a change in blood pressure during inspiration and
expiration.

DIF: Cognitive Level: Analyze REF: Pericardial Effusion

TOP: Physiological Integrity
30. A 42-year-old is diagnosed with constrictive pericarditis. The nurse assesses the blood
pressure for decreased cardiac output because of:
a. pericardial effusions.
b. fibrosis and calcification of the pericardial layers.
c. cardiomyopathy.
d. hemorrhage in the pericardial cavity.
ANS: B
In constrictive pericarditis, fibrous scarring compresses the heart and eventually reduces
cardiac output. Pericardial effusion is manifested by chest pain. Cardiomyopathy is a general
term for pathophysiological changes in the heart. Hemorrhage in the pericardial cavity will
lead to tamponade.

DIF: Cognitive Level: Analyze REF: Constrictive Pericarditis

TOP: Physiological Integrity

31. A 60-year-old patient with female genitalia has survived a myocardial infarction. The nurse is
providing care for impaired ventricular function because:
a. there is a temporary alteration in electrolyte balance.
b. there is too much stress on the heart.
c. the cells become hypertrophic.
d. the resulting ischemia leads to hypoxic injury and myocardial cell death.
ANS: D
The patient has impaired ventricular functioning because a portion of the myocardium has
died due to ischemia. Impaired ventricular function is due to damage to the myocardium; it is
not due to electrolyte imbalance. There was stress on the heart, but the impaired functioning is
due to myocardial damage secondary to ischemia. The impaired ventricular dysfunction is due
to myocardial cell death, not hypertrophy.

DIF: Cognitive Level: Understand REF: Myocardial Ischemia

TOP: Physiological Integrity

32. Many valvular stenosis and regurgitation disorders in adults have a common etiology. Which
of the following conditions should alert the nurse that the patient may have both types of
valve dysfunctions?
a. Heart failure
b. Connective tissue disorders
c. Rheumatic fever or heart disease
d. Syphilis infection
ANS: C
Valvular dysfunction is often related to rheumatic fever. Heart failure decreases cardiac output
but does not affect valvular function. It is not due to connective tissue disorders. Syphilis
infection could affect valves, but it is not the most common cause.

DIF: Cognitive Level: Understand REF: Valvular Dysfunction

TOP: Physiological Integrity

33. Which valvular condition is characterized by the valve opening being constricted and
narrowed, preventing blood from flowing forward?
a. Regurgitation
 b. Insufficiency
c. Stenosis
d. Incompetence
ANS: C
Valvular stenosis occurs when the valve opening is constricted and narrowed, increasing
cardiac workload proximal to the stenosis. Valvular regurgitation occurs when blood moves
backward into the chamber from which it came. Valvular insufficiency occurs when blood
regurgitates backward into the chamber from which it came. Valvular incompetence leads to
regurgitation.

DIF: Cognitive Level: Understand REF: Valvular Dysfunction

TOP: Physiological Integrity

34. A 67-year-old was previously diagnosed with rheumatic heart disease. Tests now show
chronic inflammation that impairs blood flow from the left ventricle into the aorta. Which
diagnosis does this history support?
a. Aortic regurgitation
b. Aortic stenosis
c. Mitral regurgitation
d. Mitral stenosis
ANS: B
Aortic stenosis would impair blood flow from the left ventricle to the aorta. Aortic
regurgitation would allow blood to flow back into the left ventricle. Mitral regurgitation
would allow blood to flow from the left ventricle to the left atrium. Mitral stenosis would
impair blood flow from the left atrium to the left ventricle.

DIF: Cognitive Level: Analyze REF: Aortic Stenosis

TOP: Physiological Integrity

35. What chamber is unable to empty completely in the presence of mitral stenosis?
a. Right atrium
b. Right ventricle
c. Left atrium
d. Left ventricle
ANS: C
Mitral stenosis would result in incomplete emptying of the left atrium, as the mitral valve is
located between the left atrium and left ventricle.

DIF: Cognitive Level: Understand REF: Mitral Stenosis

TOP: Physiological Integrity

36. A 72-year-old has a history of hypertension and atherosclerosis. An echocardiogram reveals

backflow of blood into the left ventricle. Which of the following is the most likely diagnosis
documented on the chart?
a. Mitral regurgitation
b. Mitral stenosis
c. Aortic regurgitation
d. Aortic stenosis
 ANS: C
Aortic regurgitation would allow backward flow of blood into the left ventricle. Mitral
regurgitation would allow backward flow of blood into the left atrium. Mitral stenosis would
impede blood flow from the right atrium into the right ventricle. Aortic stenosis would impede
blood flow into the aorta.

DIF: Cognitive Level: Analyze REF: Regurgitation

TOP: Physiological Integrity

37. Upon assessment of the patient, the nurse finds a widened pulse pressure and throbbing
peripheral pulses. Which valve disorder does the nurse suspect?
a. Mitral regurgitation
b. Mitral stenosis
c. Aortic regurgitation
d. Aortic stenosis
ANS: C
Aortic regurgitation is manifested by widened pulse pressure resulting from increased stroke
volume and diastolic backflow. Mitral regurgitation is manifested by heart failure.
Mitral stenosis is manifested by pulmonary edema and heart failure. Aortic stenosis is
manifested by narrowed pulse pressure.

DIF: Cognitive Level: Analyze REF: Regurgitation

TOP: Physiological Integrity

38. A 35-year-old presents with pulmonary hypertension and is diagnosed as being in right heart
failure. Which is the most likely cause of this condition?
a. Aortic stenosis
b. Tricuspid regurgitation
c. Aortic regurgitation
d. Mitral regurgitation
ANS: B
Tricuspid regurgitation leads to volume overload in the right atrium and ventricle, increased
systemic venous blood pressure, and right heart failure. Aortic stenosis is manifested by
narrowed pulse pressure. Aortic regurgitation is manifested by widened pulse pressure
resulting from increased stroke volume and diastolic backflow. Mitral regurgitation is
manifested by heart failure but not pulmonary hypertension.

DIF: Cognitive Level: Analyze REF: Regurgitation

TOP: Physiological Integrity

39. A nurse recalls that the most common cardiac valve disorder is:
a. mitral valve prolapse.
b. pulmonary stenosis.
c. tricuspid valve prolapse.
d. aortic stenosis.
ANS: D
Aortic stenosis is the most common valvular disorder. Pulmonary stenosis and tricuspid valve
prolapse are less common. Mitral valve prolapse is common when rheumatic heart disease is
present.
 DIF: Cognitive Level: Understand REF: Aortic Stenosis
TOP: Physiological Integrity

40. A 10-year-old child with male genitalia presents with fever, lymphadenopathy, arthralgia, and
nosebleeds. The child is diagnosed with rheumatic heart disease. What is the most likely cause
of this disease?
a. Congenital heart defects
b. Human immunodeficiency virus (HIV) infections
c. Group A beta-hemolytic streptococcus infections
d. Acute pericarditis
ANS: C
Rheumatic fever is a systemic, inflammatory disease caused by a delayed exaggerated
immune response to infection by the group A beta-hemolytic streptococcus, not by congenital
heart defects, HIV infections, or acute pericarditis.

DIF: Cognitive Level: Analyze

REF: Acute Rheumatic Fever and Rheumatic Heart Disease TOP: Physiological Integrity

41. A 10-year-old child with male genitalia presents with fever, lymphadenopathy, arthralgia, and
nosebleeds and is diagnosed with rheumatic heart disease. While planning care, which
characteristic changes should the nurse remember?
a. Blood-borne organisms that adhere to the valvular surface
b. Antigens that bind to the valvular lining, triggering an autoimmune response
c. High fevers that damage collagen in valve leaflets
d. Rheumatoid factor in the blood, stimulating valvular degeneration
ANS: B
The immune response cross-reacts with molecularly similar self-antigens in heart, muscle,
joints, and the brain, causing an autoimmune response resulting in diffuse, proliferative, and
exudative inflammatory lesions in these tissues. It is not due to blood-borne organisms, high
fevers, or rheumatoid factors.

DIF: Cognitive Level: Understand

REF: Acute Rheumatic Fever and Rheumatic Heart Disease TOP: Physiological Integrity

42. A 30-year-old patient with female genitalia presents to her primary care provider with fever,
cardiac murmur, and petechial skin lesions and is diagnosed with infective endocarditis. What
is the most likely cause of the disease?
a. Bacteria
b. Viruses
c. Fungi
d. Parasites
ANS: A
Infective endocarditis is due to a bacterial infection, not a viral, fungal, or parasitic infection.

DIF: Cognitive Level: Understand REF: Infective Endocarditis

TOP: Physiological Integrity
43. Why do inflammatory cells have difficulty limiting the colonization of microorganisms in
infective endocarditis?
a. The microorganisms are highly resistant.
b. The valves are avascular.
c. Microorganisms become embedded in fibrin clots.
d. Microbial colonies overwhelm the phagocytes.
ANS: C
In endocarditis, bacterial colonies are inaccessible to host defences because they are
embedded in the protective fibrin clots; it is not because the microorganisms are resistant, that
the valves are avascular, or that the colonies overwhelm the phagocytes.

DIF: Cognitive Level: Understand REF: Infective Endocarditis

TOP: Physiological Integrity

44. Which characteristic changes should the nurse keep in mind while caring for a patient with
progressive left heart failure?
a. Left ventricular preload increases
b. Systemic vascular resistance decreases
c. Left end-diastolic volume decreases
d. Pulmonary vascular resistance decreases
ANS: A
Left ventricular preload increases in left heart failure because less blood is ejected from the
left ventricle. Left heart failure does not lead to a decrease in systemic resistance; it leads to an
increase in resistance. Left end-diastolic volume will increase. Pulmonary vascular resistance
will increase.

DIF: Cognitive Level: Understand REF: Left Ventricular Failure

TOP: Physiological Integrity

45. A 65-year-old patient with male genitalia with a history of untreated hypertension is now
experiencing left heart failure. A nurse recalls that his untreated hypertension led to:
a. ventricular dilation and wall thinning.
b. myocardial hypertrophy and ventricular remodelling.
c. inhibition of renin and aldosterone.
d. alterations in alpha and beta receptor function.
ANS: B
With hypertension comes increased afterload and resistance to ventricular emptying and more
workload for the ventricle, which responds with hypertrophy of the myocardium and
ventricular remodelling. Ventricular dilation can occur, but the wall will thicken, not thin.
Renin and aldosterone release are increased, not inhibited. Alterations in alpha and beta
functioning may occur, but the response to hypertension is myocardial hypertrophy and
ventricular remodelling.

DIF: Cognitive Level: Understand REF: Left Ventricular Failure

TOP: Physiological Integrity

46. A patient with left heart failure starts to have a cough and dyspnea. Why does this happen?
a. Pulmonary symptoms are due to inflammatory pulmonary edema.
b. There is a decreased cardiac output.
 c. Left heart failure results in pulmonary vascular congestion.
d. Reflexive bronchoconstriction occurs.
ANS: C
The clinical manifestations of left heart failure are the result of pulmonary vascular congestion
and inadequate perfusion of the systemic circulation. Pulmonary edema does occur, but it is
not due to inflammation. Decreased cardiac output does occur, but the pulmonary symptoms
are related to pulmonary congestion. Pulmonary symptoms are not due to bronchoconstriction.

DIF: Cognitive Level: Understand REF: Left Ventricular Failure

TOP: Physiological Integrity

47. A patient was admitted to the intensive care unit with a diagnosis of acute myocardial
infarction (MI) and is being treated for shock. The primary cause of shock is most likely:
a. rapid heart rate.
b. decreased cardiac contractility.
c. increased capillary permeability.
d. decreased afterload due to vasodilation.
ANS: B
MI leads to decreased cardiac contractility due to a damaged myocardium and would lead to
shock. A rapid heart rate would not cause shock. Increased capillary permeability would not
lead to shock. Decreased afterload will not lead to shock associated with MI.

DIF: Cognitive Level: Analyze REF: Cardiogenic Shock

TOP: Physiological Integrity

48. A 73-year-old patient has increased pulmonary pressure resulting in right heart failure. What
is a potential cause for the right heart to fail?
a. Hypertension
b. Left heart failure
c. Acute pneumonia
d. Pericarditis
ANS: B
Right-sided failure often follows left-sided failure when pulmonary congestion forces
backward flow of blood into the left ventricle. It is not due to hypertension, pneumonia, or
pericarditis.

DIF: Cognitive Level: Understand REF: Right Ventricular Failure

TOP: Physiological Integrity

49. A 65-year-old patient with male genitalia is diagnosed with chronic pulmonary disease and
elevated pulmonary vascular resistance. Which of the following heart failures should the nurse
assess for in this patient?
a. Right heart
b. Left heart
c. Low-output
d. High-output
ANS: A
 Right-sided failure occurs when the patient experiences chronic pulmonary disease and
elevated pulmonary vascular resistance because the blood has difficulty overcoming the
pressure and blood builds up in the right side of the heart. Pulmonary congestion leads to
right-sided failure, not left, not low-output failure, and not high-output failure.

DIF: Cognitive Level: Analyze REF: Right Ventricular Failure

TOP: Physiological Integrity

50. A 72-year-old patient with female genitalia has a history of right heart failure caused by a
right ventricular myocardial infarction. Which of the following symptoms are specifically
related to her right heart failure?
a. Significant edema to both lower legs and feet
b. Hypertension
c. Decreased urine output
d. Dyspnea upon exertion
ANS: A
Right-sided failure allows blood to back up into the systemic circulation, leading to peripheral
edema. Since it is backed up into the venous system, hypertension is less likely. Right-sided
failure leads to edema and a greater venous blood volume, which would lead to increased
urinary output. Dyspnea upon exertion is more indicating of left-sided failure.

DIF: Cognitive Level: Analyze REF: Right Ventricular Failure

TOP: Physiological Integrity

51. Which condition should cause the nurse to assess for high-output failure in a patient?
a. Metabolic alkalosis
b. Hypothyroidism
c. Hypovolemia
d. Anemia
ANS: D
Common causes of high-output failure include anemia, not metabolic alkalosis, not
hypothyroidism, and not hypovolemia.

DIF: Cognitive Level: Understand REF: High-Output Failure

TOP: Physiological Integrity

52. When a person is in shock, a nurse remembers that impairment in cellular metabolism is
caused by:
a. release of toxic substances.
b. free radical formation.
c. inadequate tissue perfusion.
d. lack of nervous or endocrine stimulation.
ANS: C
In shock, impaired cellular metabolism is caused by inadequate tissue perfusion.
Impairment of cellular metabolism is the result of inadequate tissue perfusion; toxic
substances could develop, but it would be secondary to the inadequate perfusion. Free radicals
are not the cause of impaired cellular metabolism. The lack of nervous control would lead to
vasodilation, but perfusion still occurs.
 DIF: Cognitive Level: Understand REF: Shock TOP: Physiological Integrity

53. What is one consequence of switching from aerobic to anaerobic cellular metabolism during
shock?
a. Decreased adenosine triphosphate (ATP) production
b. Cellular dehydration
c. Cellular alkalosis
d. Free radical formation
ANS: A
Anaerobic metabolism leads to decreased ATP production, not cellular dehydration, not
cellular alkalosis, and not free radical formation.

DIF: Cognitive Level: Understand REF: Shock TOP: Physiological Integrity

54. During shock states, glucose uptake is usually:

a. enhanced.
b. normal.
c. impaired.
d. energy intensive.
ANS: C
Some compensatory mechanisms activated by shock contribute to decreased glucose uptake
by the cells, not enhanced uptake, not normal uptake, and not energy-intensive uptake.

DIF: Cognitive Level: Understand REF: Shock TOP: Physiological Integrity

55. A 20-year-old patient with female genitalia is being admitted to the hospital with fever and
septic shock. Which set of assessment findings would the nurse expect the patient to exhibit?
a. Bradycardia, palpitations, confusion, truncal rash
b. Severe respiratory distress, jugular venous distension, chest pain
c. Low blood pressure and tachycardia
d. Reduced cardiac output, increased systemic vascular resistance, moist cough
ANS: C
Clinical manifestations of shock will include a low blood pressure and tachycardia.
Tachycardia, not bradycardia, will occur. Severe respiratory distress, jugular vein distension,
and chest pain are symptoms of heart failure, particularly pulmonary edema. Cardiac output is
reduced, but there is a decrease in systemic vascular resistance.

DIF: Cognitive Level: Analyze REF: Shock TOP: Physiological Integrity

56. An 82-year-old patient with female genitalia was admitted to the hospital with confusion and
severe hypotension. Their body’s compensatory mechanisms are increased heart rate,
vasoconstriction, and movement of large volumes of interstitial fluid to the vascular
compartment. What kind of shock does the nurse suspect the patient is experiencing?
a. Anaphylactic
b. Hypovolemic
c. Neurogenic
d. Septic
ANS: B
 In hypovolemic shock, heart rate and SVR increase, boosting both cardiac output and tissue
perfusion pressures. Interstitial fluid moves into the vascular compartment. In anaphylactic
shock, bronchoconstriction occurs with hypotension. In neurogenic shock, hypotension
occurs, but fluid does not shift. In septic shock, interstitial fluid shift does not occur.

DIF: Cognitive Level: Understand REF: Figure 24.43 TOP: Physiological Integrity

57. A 27-year-old patient with male genitalia is admitted to a neurological unit with a complete
C-5 spinal cord transection. On initial assessment, the patient is bradycardic, hypotensive, and
hyperventilating. The patient appears to be going into shock. What is the most likely
mechanism of this patient’s shock?
a. Hypovolemia caused by blood loss
b. Hypovolemia caused by evaporative fluid losses
c. Vasodilation caused by Gram-negative bacterial infection
d. Vasodilation caused by a decrease in sympathetic stimulation
ANS: D
The patient is experiencing neurogenic shock in which blood volume has not changed, but
SVR decreases drastically so that the amount of space containing the blood has increased,
leading to hypotension. In this type of shock, blood loss has not occurred. In this type of
shock, fluid loss has not occurred. Vasodilation due to infection would be septic shock; the
type of shock described in the patient is due to loss of sympathetic stimulation.

DIF: Cognitive Level: Analyze REF: Figure 24.44 TOP: Physiological Integrity

58. Neurogenic shock can be caused by any factor that inhibits the:
a. parasympathetic nervous system.
b. sympathetic nervous system.
c. somatic nervous system.
d. thalamus.
ANS: B
Neurogenic shock is caused by any factor that inhibits the sympathetic nervous system or
overstimulates the parasympathetic nervous system. Neurogenic shock is not caused by
inhibition of the somatic system or of the thalamus.

DIF: Cognitive Level: Understand REF: Neurogenic Shock

TOP: Physiological Integrity

59. A 15-year-old patient with male genitalia who is allergic to peanuts eats a peanut butter cup.
The patient then goes into anaphylactic shock. Which assessment findings will the nurse
assess for?
a. Bradycardia, decreased arterial pressure, and oliguria
b. Bronchoconstriction, hives or edema, and hypotension
c. Hypertension, anxiety, and tachycardia
d. Fever, hypotension, and erythematous rash
ANS: B
Anaphylactic shock is characterized by bronchoconstriction, hives, and hypotension; it does
not involve oliguria, bradycardia, or hypotension. Septic shock, not anaphylactic shock, is
manifested by fever and rash.
 DIF: Cognitive Level: Understand REF: Anaphylactic Shock
TOP: Physiological Integrity

60. The onset of anaphylactic shock is usually:

a. mild.
b. sudden and life-threatening.
c. delayed by several hours.
d. delayed by 24 hours.
ANS: B
The onset of anaphylactic shock is usually sudden and life-threatening, not mild or delayed.

DIF: Cognitive Level: Understand REF: Anaphylactic Shock

TOP: Physiological Integrity

61. For an infection to progress to septic shock, what must occur?

a. The individual must be immunosuppressed.
b. The myocardium must be impaired.
c. The infection must be Gram negative.
d. Bacteria must enter the bloodstream.
ANS: D
For septic shock to occur, bacteria must enter the bloodstream. Septic shock can occur in
individuals who are not immunosuppressed. In septic shock, the myocardium is not impaired.
Many organisms in addition to Gram-negative bacteria can cause septic shock.

DIF: Cognitive Level: Understand REF: Septic Shock

TOP: Physiological Integrity

62. What condition leaves a patient most prone to multiple organ dysfunction syndrome
(MODS)?
a. Myocardial infarction (MI)
b. Pulmonary disease
c. Septic shock
d. Autoimmune disease
ANS: C
The most common cause of MODS is septic shock, not MI, not pulmonary disease, and not
autoimmune disease.

DIF: Cognitive Level: Understand REF: Septic Shock

TOP: Physiological Integrity

63. A 75-year-old patient with female genitalia has been critically ill with multiple organ
dysfunction syndrome (MODS) for longer than a week and has developed a severe oxygen
supply and demand imbalance. What statement best describes this imbalance?
a. Increased oxygen delivery to cells fails to meet decreased oxygen demands.
b. The amount of oxygen consumed by cells depends only on the needs of cells,
because there is oxygen in reserve.
c. The situation results in supply-independent consumption.
d. The oxygen reserve has been exhausted, leaving oxygen consumption dependent
 on what amount the circulation is able to deliver.
ANS: D
In MODS, the reserve has been exhausted and the body cannot meet the oxygenation
demands. It is true that oxygen fails to meet demand, but there is no increase in oxygen
because reserves are exhausted. There is no oxygen in reserve. The situation is supply and
demand, but the demand cannot be met.

DIF: Cognitive Level: Analyze REF: Septic Shock

TOP: Physiological Integrity

64. Which of the following is a management strategy for Raynaud’s phenomenon?

a. The patient should eat bananas twice a day.
b. The patient should stop smoking cigarettes.
c. The patient should wear mittens inside.
d. The patient should take calcium channel blockers.
ANS: B
Cigarette smoking should be stopped to eliminate the vasoconstricting effects of nicotine.
Eating bananas is not a management strategy. The patient should wear mittens outside, not
necessarily inside. Calcium channel blockers are an acceptable treatment for Raynaud’s
phenomenon.

DIF: Cognitive Level: Understand REF: Raynaud’s Phenomenon

TOP: Physiological Integrity

MULTIPLE RESPONSE

1. A nurse recalls that acute orthostatic hypotension can be caused by which of the following?
(Select all that apply.)
a. Prolonged immobility
b. Drug action
c. Starvation
d. Volume depletion
e. Exercise
ANS: A, B, C, D
Acute orthostatic hypotension occurs as a result of drug action, prolonged immobility,
starvation, and volume depletion. Physical exhaustion, rather than exercise, could cause
orthostatic hypotension.

DIF: Cognitive Level: Understand REF: Orthostatic (Postural) Hypotension

TOP: Physiological Integrity