___ 1. Which of the following individuals is the most likely to have a silent myocardial
infarction (MI)?
A) A young male
B) A middle-aged female
C) A pregnant female
D) A male diagnosed with diabetes mellitus
___ 2. The nurse recognizes which of the following as the most critical assessment finding
when caring for the patient at risk for hypovolemic shock?
A) Skin flushed and warm
B) Decreased urine output
C) Bounding peripheral pulse
D) Temperature decreases
___ 3. A patient presents to the Emergency Department complaining of severe chest pain.
Upon examination, you note a temperature of 102.5, white blood count of 20,000, and
a pericardial friction rub. You should expect which of the following?
A) Infective endocarditis.
B) Cardiac tamponade.
C) Myocarditis.
D) Pericarditis.
___ 4. Which of the following laboratory tests would be indicative of worsening heart
failure?
A) Elevated hemoglobin.
B) Elevated b-type natriuretic peptide (BNP).
C) Decreased myoglobin.
D) Decreased b-type natriuretic peptide (BNP).
___ 5. Which of the following is most likely to contribute to thrombus development?
A) Over hydration
B) Ambulation
C) Immobility
D) Infection
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___ 6. Pericardial effusion that can occur in pericarditis has which of the following
cardiovascular consequences?
A) Decreased preload
B) Decreased afterload
C) Decreased cardiac output
D) Decreased peripheral vascular resistance
___ 7. A patient comes to the Emergency Department complaining of coughing and
difficulty breathing. The patient's diagnosis is heart failure. He asks you how
difficulty breathing could be a heart problem. What is the best response?
A) "The left side of your heart is weak and pumps blood too quickly."
B) "The left side of your heart has weakened and blood has entered your lungs."
C) "The right side of your heart has enlarged and cannot effectively pump blood."
D) "The right side of your heart has weakened and blood has entered your lungs."
___ 8. Which type of cardiomyopathy is characterized by progressive cardiac hypertrophy,
dilation, and impaired pumping with heart enlargement and thinning walls?
A) Dilated.
B) Hypertrophic.
C) Restrictive.
D) Peripartum.
___ 9. Which type of valvular heart disease causes obstruction of the ejection of blood from
the left atrium to the left ventricle?
A) Aortic stenosis
B) Aortic regurgitation
C) Mitral stenosis
D) Mitral regurgitation
___ 10. A 19-year old athlete went out for his first day of football practice. He experienced
sudden cardiac death. The cause of death was determined to be cardiomyopathy.
Which form of cardiomyopathy was it most likely to be?
A) Dilated
B) Hypertrophic
C) Restrictive
D) Dystrophic
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___ 11. The nurse will monitor a patient for which clinical manifestation as a compensatory
mechanism to the initial stage of shock?
A) Decreased mean arterial pressure
B) Elevated body temperature
C) Vascular vasodilation
D) Increased heart rate
___ 12. The nurse recognizes the patient with which disorder is at greatest risk for
hypovolemic shock?
A) Burns
B) Sepsis
C) Pericarditis
D) Myopathies
___ 13. Which of the following patients has the greatest risk of developing heart failure?
A) A 50-year-old white female with asthma.
B) A 48-year-old black female who smokes.
C) A 69-year-old black male with hypertension.
D) A 75-year-old white male who smokes.
___ 14. Which of the following is a modifiable risk factor for coronary artery disease?
A) Family history.
B) Smoking.
C) Gender.
D) Age.
___ 15. Your patient with a history of stable angina states that he has recently experienced an
increase in the number of attacks and the intensity of the pain. What should you
suspect?
A) The patient continues to have stable angina
B) The patient has developed unstable angina
C) The patient has experienced an acute MI
D) The patient has a subendocardial necrosis
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___ 16. With which of the following patients should you remain alert to the possible
development of right-sided heart failure?
A) 60-year-old man chronic obstructive pulmonary disease
B) 40-year-old woman who broke an ankle while training for a marathon
C) 68-year-old man with dehydration 5 years after having a myocardial infarction
D) 27-year-old woman taking excessive amounts of thyroid hormone to promote
weight loss
___ 17. A 80 y/o patient in the intensive care unit with an overwhelming systemic infection
begins to exhibit splinter hemorrhages under her fingernails, hematuria, and petechia.
What would be the likely culprit?
A) Cardiac tamponade.
B) Infective endocarditis.
C) Dilated cardiomyopathy.
D) Pericarditis.
___ 18. A severely obese patient presents to the clinic with edema of the right lower extremity
that is impairing ambulation. Upon inspection, the health care provider notes that the
edema does not indent with pressure, the skin on the right lower extremity is thick
and rough, and distal pulses are present and equal bilateral. The health care provider
should expect which of the following?
A) Peripheral vascular disease.
B) Congested heart failure.
C) Deep vein thrombosis.
D) Lymphedema.
___ 19. The nurse is providing group education about lipids to patients who have been
diagnosed with hyperlipidemia. What does the best instruction include?
A) High density lipoprotein (HDL) is called good cholesterol because it increases
the oxygen content in the arteries and stabilizes plaque build-up.
B) High density lipoprotein (HDL) is called good cholesterol because it removes
cholesterol from your body and gets rid of it in your liver.
C) High density lipoprotein (HDL) is called good cholesterol because it deceases
cardiac workload by decreasing oxygen consumption your heart.
D) High density lipoprotein (HDL) decreases low density lipoprotein (LDL) and
prevents it from converting to very low density lipoprotein (VDRL), which is the
worst kind of cholesterol in the body.
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___ 20. Which patient is most at risk of developing left-sided heart failure?
A) 64-year-old female with mitral valve stenosis
B) 60-year-old male with pulmonary hypertension
C) 48-year-old female who smokes one pack of cigarettes daily
D) 72-year-old male who has had a right ventricular myocardial infarction
___ 21. On an electrocardiogram (EKG), the p wave represents which of the following?
A) Atrial depolarization
B) Ventricular depolarization.
C) Atrial repolarization.
D) Ventricular repolarization.
___ 22. The QRS wave of an electrocardiogram (EKG) is produced by:
A) depolarization of the atria
B) repolarization of the atria
C) depolarization of the ventricles
D) repolarization of the ventricles
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___ 23. The renin-angiotensin-aldosterone pathway:
A) is activated by renin
B) acts to decrease loss of sodium in urine
C) increases in activity in response to blood loss
D) can be blocked to help lower blood pressure
E) all of the above
___ 24. Which of the following is not a risk factor for the development of atherosclerotic
heart disease?
A) Hypertension
B) Diabetes Mellitus
C) Hyperthyroidism
D) Cigarette Smoking
E) Metabolic syndrome
___ 25. A 55 year-old male with hypertension presents to the emergency room with acute
onset of crushing substernal chest pressure while mowing his lawn. He presents to
the emergency room, where his EKG is consistent with acute anterior myocardial
infarction. Decision is made to transport the patient to the cardiac catherization lab.
In a patient with an acute coronary syndrome, what is the goal time from presentation
to hospital to opening of the artery (i.e. door to balloon time)?
A) 30 minutes or less
B) 60 minutes or less
C) 90 minutes or less
D) 120 minutes or less
___ 26. Which of the following is not part of the definition of the metabolic syndrome?
A) Men’s waist circumference greater than 40 inches
B) Fasting glucose > 100 mg/dl
C) HDL < 50 mg/dl in women
D) Systolic blood pressure > 110 mm/Hg
E) Triglycerides > 150 mg/dl
___ 27. ________ stoke is when the blood flow is interrupted due to a blockage in an artery as
opposed to ________ stroke which involves a rupture.
A) Ischemic, hemorrhagic
B) Hemorrhagic, Ischemic
C) Acute, chronic
D) None of the above
___ 28. Narrowing and hardening of arteries is known as ________________.
A) atherosclerosis
B) thrombosis
C) stroke
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D) hemorrhage
___ 29. Which of the following is not a non-modifiable risk factor for stroke.
A) age
B) being of the female gender
C) family history
D) ethnicity
___ 30. The most likely place for a thrombosis to form postoperatively is:
A) the lungs.
B) the left side of the heart.
C) the legs.
D) anywhere in the body.
___ 31. Which of the following statements relating to congestive failure is INCORRECT?
A) It may follow any type of heart disease.
B) It leads to excretion of excessive amounts of salt and water by the kidneys.
C) Venous pressure is elevated.
D) Blood volume is increased.
___ 32. Which of the following statements related to infective endocarditis (bacterial
endocarditis) is INCORRECT?
A) It is a complication of valvular heart disease.
B) Fibrin-platelet thrombi form on rough valve surface; bacteria implant in the
thrombus and incite inflammation.
C) Microorganisms never implant on a normal heart valve.
D) Part of valve vegetations may break loose and be carried into the circulation as
emboli.
___ 33. Which is the most serious complication of an aortic aneurysm?
A) Dilation of the aorta, which may compress adjacent abdominal organs
B) Formation of the thrombi on the rough intimal surface on the aneurysm wall
C) Rupture of the aneurysm
D) Degeneration and calcification of the aneurysm wall
___ 34. What is one of the most important complications of mitral valve scarring due to
rheumatic fever?
A) Infective (bacterial) endocarditis
B) Aortic aneurysm
C) Hemolytic anemia
D) Chronic iron deficiency
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___ 35. Angina pectoris is usually a manifestation of which of the following?
A) Hypertension
B) Atherosclerosis of coronary arteries
C) Aortic aneurysm
D) Infective (bacterial endocarditis)
___ 36. What is the mechanism of death following cardiac tamponade?
A) Impaired cardiac contraction due to inflammation surrounding a myocardial
infarction
B) Compression of the heart by the blood on the pericardial sac, which impairs
filling in diastole
C) Over distension of the ventricles due to heart failure
D) Spasm of coronary arteries
___ 37. Which of the following cardiac valve abnormalities occurs most frequently in young
women?
A) Aortic stenosis caused by calcification of the aortic valve
B) Mitral stenosis caused by scarring resulting from a previous episode of acute
rheumatic fever
C) Mitral valve prolapse
D) Aortic valve incompetence (aortic insufficiency) caused by previous rheumatic
fever
E) Idiopathic hypertrophic subaortic stenosis (IHHS)
___ 38. Why do cardiac enzymes rise after an acute myocardial infarction?
A) White cells are attracted to the site of muscle injury.
B) Injured fibers increase their synthesis of cardiac muscle enzymes.
C) Cardiac enzymes leak from the damaged muscle fibers into the bloodstream.
D) Blood flow to the injured muscle is increased.
___ 39. Aldosterone primarily affects which of the following?
A) Carbohydrate metabolism
B) Protein and fat metabolism
C) Salt and water metabolism
D) Protein and water metabolism
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Answer Key
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
D
B
D
B
C
C
B
A
C
B
D
A
C
B
B
A
B
D
B
A
A
C
E
C
C
D
A
A
B
C
B
C
C
A
B
B
C
C
C
Rationales
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1. Silent MIs refers to MIs without usually manifestations (i.e. angina). This typically
occurs in patients with a history of diabetes mellitus and a previous MI because of
decreased nerve innervation.
2. In hypovolemic shock, tissue perfusion is diminished because of decreased circulating
blood volume. The kidneys are often affected most severely to this decreased tissue
perfusion. Urine output is directly affected by renal blood flow. Decreased urine output
would be an early indicator that the kidneys were not receiving adequate blood flow. Skin
would become cool and pale with hypovolemic shock because of the decreased
circulating blood volume. The peripheral pulse would become weak and thready because
of the decreased circulating blood volume. Temperature may decrease, but it is not a
critical finding.
3. Severe sharp chest pain, fever, leukocytosis, and a pericardial friction rub are classic
presentation of pericarditis. Fever and leukocytosis may be present with infective
endocarditis, but chest pain and friction rubs are not typically associated with it. Cardiac
tamponade is not generally associated with any of these symptoms. Chest pain, fever, and
leukocytosis may be present with myocareditis, but the friction rub is not associated with
it.
4. When the heart stretches to accommodate the excessive blood volume with worsening
heart failure or during heart failure exacerbations, BNP is released. BNP levels can
become significantly elevated during those times. These levels will gradual return to
normal during treatment and when managed. Anemia, including decreased hemoglobin,
can be a complication of heart failure because of decreasing renal function, but increased
hemoglobin levels are not generally associated with worsening heart failure. Decreased
myoglobin is not generally associated with heart failure.
5. The main contributors to thrombus formation are referred to as Virchow's triad
(hypercoagulation, blood stagnation, and increased blood viscosity). Immobility
contributes to thrombus formation because of increasing blood stagnation. Overhydration
and ambulation would decrease thrombus risk. Infection does have a significant impact
on thrombus formation.
6. Pericardial effusion refers to fluid accumulation in the pericardial sac, which has limited
give to it. The fluid accumulation compresses the heart and limits the hearts ability to
expand to fill with blood. This limited expansion results in decreased cardiac output. This
creates a back up of the system, which would increase preload, afterload, and peripherial
vascular resistance not decrease them.
7. Left-sided heart failure leads to respiratory manifestations because blood backs up into
the lungs. It does not occur because the heart is pumping too fast. Right-sided heart
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failure leads to more systemic manifestations because of blood backing up into the
periphery.
8. With dilated cardiomyopathy, the heart stretches and thins. Hypertrophy, heart
enlargement, and impaired pumping may occur with the other types of cardiomyopathy.
The thinning of the heart wall is specific to dilated cardiomyopathy.
9. The mitral valve is the valve between left atrium and left ventricle. Stenosis is a
narrowing of the valve, and regurgitation allows the blood to flow in both directions
instead of in one. Mitral stenosis would prevent the flow of blood from the left atrium to
ventricle. The aortic valve positioned between the left ventricle and aorta, and, therefore,
would not impact the flow between the left atrium and ventricle.
10. Hypertrophic cardiomyopathy is often a result of a congenital abnormality that often goes
undiagnosed until a time of increased cardiac workload, as with playing sports. This type
of cardiomyopathy usually results in cardiac death at that time. These events are not
generally associated with the other types of cardiomyopathy.
11. Initially, shock triggers the sympathetic nervous system which causes the release of
epinephrine and norepinephrine. The stimulation of the sympathetic nervous system
results in tachycardia in an attempt to circulate the available blood volume to meet the
body's needs. The mean arterial pressure may decrease but it is not compensatory.
Vasodilatation would worsen the condition by further lowering the blood pressure. An
elevation in temperature would worsen the condition as well by increasing oxygen
demand on an already strained system.
12. Burns cause hypovolemic shock, especially burns covering a vast surface area, because
the heat denatures the proteins that control colloidal pressure. The loss of colloidal
pressure allows fluid to shift out of the vascular space into the interstitial space, lowering
blood volume. Sepsis leads to septic shock. Pericarditis and myopathies result in
cardiogenic shock.
13. The 69 year old has two significant risk factors: advancing age and hypertension.
Hypertension that is often seen in African Americans is more severe and harder to
manage. Hypertension directly causes heart failure because it overworks the heart
muscle.
14. All of the options are risk factors of coronary artery disease, but smoking is the only one
that is modifiable.
15. If angina changes in quality, increases in frequency, or worsens, then unstable angina is
expected. Unstable angina may lead to an acute MI but more diagnostic procedures
would be necessary to determine if an MI was occurred.
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16. Right-sided heart failure often results from a pulmonary problem, such as chronic
obstructive pulmonary disease. The 40 year old and 68 year old does not have any risk
factors for any heart failures. The 27 year old would be at risk for high output failure but
not right-sided failure.
17. Infective endocarditis causes manifestations of microhemorrhages because of the
vegetative growth on the valves that become microemboli. The emboli occlude the
microcirculation, causing hemorrhages. This is not associated with the other conditions.
18. Lymphedema is common in obese individuals because the pressure the excessive weight
on the lymph system. Lymphedema results in non-pitting edema and skin changes, but no
changes in pulses because it is not a issue with the cardiovascular system. Peripheral
vascular disease can causes skin changes, but it is usually causes discoloration and
thinking of the skin. Additionally, pulse changes are often seen with peripheral vascular
disease. Congested heart failure may be associated with obesity, but it usually causes
pitting edema and pulse changes. Deep vein thrombosis is associated with pitting edema,
pulse changes, and skin temperature changes.
19. HDL is referred to as the "good cholesterol" because it assist with the removal of
cholesterol from the body. It does not increase oxygen saturation, stabilize plaque
buildup, decrease cardiac workload, or prevent conversion of LDL to VDRL.
20. The mitral valve is between the left atrium and left ventricle. Mitral valve stenosis
prevents blood flow from the left atrium to ventricle. Cardiac workload increases in an
attempt to compensate for the falling cardiac output. Pulmonary hypertension, smoking,
and right ventricular MI would increase the risk for right-sided heart failure, but not leftsided failure.
21. The P wave on an EKG represents atrial depolarization. The QRS complex represents
ventricular depolarization. The T wave represents ventricular repolarization. Atrial
repolarization is often not seen on an EKG.
22. The QRS complex represents ventricular depolarization. The P wave on an EKG
represents atrial depolarization. The T wave represents ventricular repolarization. Atrial
repolarization is often not seen on an EKG.
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