Mandated Reporter

Review your state’s mandated reporter statute. Provide details about this in your post. If faced with a mandated reporter issue, what are the steps in reporting the issue? Create a mandated reporter scenario and post it. Respond to one of your peer’s scenarios using the guidelines for submission/reporting in your state. Be sure to include a reference to your state’s website related to mandated reporting.

***THIS IS MY PEER’S SCENARIO I WANT TO RESPOND TO:

Scenario:

“A mother brings her one year old son to the emergency room. She looks very concerned about the pain her child experiences in his leg, after “he fell off the stairs” as she mentioned. The X-ray showed a spiral fracture . Moreover, during physical examination, you notice fading bruises and lacerations on various part of the body surfaces. What should you do as RN taking care of the patient?”

(***THIS POST CAN’T BE MORE THAN 300 WORDS)

nr507 Week 3 quiz 2016 (Score 100%)

Question

Question 1.1. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician. As part of the patient’s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring? (Points : 0.4)

A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity.

The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies.

Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording.

Holter monitors are normally set to record electrical activity of the heart at least once per hour.

Question 2.2. 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 3.3. 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 4.4. 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)

Pheochromocytoma

Essential hypertension

Coarctation of the aorta

An adrenocortical disorder

Question 5.5. 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 6.6. 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 7.7. 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 8.8. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient’s most likely diagnosis? (Points : 0.4)

Hypovolemic shock

Septic shock

Neurogenic shock

Obstructive shock

Question 9.9. 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)

Signal-averaged ECG

Exercise stress testing

Electrophysiologic study

Holter monitoring

Question 10.10. A nurse practitioner is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor? (Points : 0.4)

A 61-year-old man who has a heart valve infection and recurrent fever

An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness

A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week

A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

Question 11.11. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?(Points : 0.4)

Increased preload due to vascular resistance

High afterload because of backpressure against the left ventricle

Impaired contractility due to aortic resistance

Systolic impairment because of arterial stenosis

Question 12.12. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)

A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort

A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin

A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

Question 13.13. 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

Question 14.14. An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner’s choice of blood work? (Points : 0.4)

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology.

BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.

BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.

BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

Question 15.15. 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 16.16. 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 17.17. 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 18.18. 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 19.19. 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 20.20. 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 21.21. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms.Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? (Points : 0.4)

Aneurysms are commonly a result of poorly controlled diabetes mellitus.

Hypertension is a frequent modifiable contributor to aneurysms.

Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures.

Aneurysms can normally be resolved with lifestyle and diet modifications.

Question 22.22. 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 23.23. 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 24.24. An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0.4)

An increase in preload via the Frank-Starling mechanism

Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine

Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP)

AV node pacemaking activity and vagal nerve suppression

Question 25.25. 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.

1. A nurse practitioner is teaching a student NP about the physiologic basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by the student would warrant correction by the nurse practitioner? (Points : 0.4)

“As vessel wall thickness increases, tension decreases.”

“Smaller blood vessels require more pressure to overcome wall tension.”

“The smaller the vessel radius, the greater the pressure needed to keep it open.”

“Tension and vessel thickness increase proportionately.”

Question 2.2. 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)

Signal-averaged ECG

Exercise stress testing

Electrophysiologic study

Holter monitoring

Question 3.3. 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 4.4. An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0.4)

An increase in preload via the Frank-Starling mechanism

Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine

Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP)

AV node pacemaking activity and vagal nerve suppression

Question 5.5. 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 6.6. 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 7.7. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)

A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort

A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin

A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

Question 8.8. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient’s most likely diagnosis? (Points : 0.4)

Hypovolemic shock

Septic shock

Neurogenic shock

Obstructive shock

Question 9.9. 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

Question 10.10. An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner’s choice of blood work? (Points : 0.4)

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology.

BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.

BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.

BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

Question 11.11. 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.

Question 12.12. 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 13.13. Which of the following situations related to the transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? (Points : 0.4)

Pressure in the pulmonary circulation and the right side of the infant’s heart fall markedly.

Alveolar oxygen tension increases, causing reversal of pulmonary vasoconstriction of the fetal arteries.

Systemic vascular resistance and left ventricular pressure are both increasing.

Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant’s first week.

Question 14.14. 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 15.15. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms.Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? (Points : 0.4)

Aneurysms are commonly a result of poorly controlled diabetes mellitus.

Hypertension is a frequent modifiable contributor to aneurysms.

Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures.

Aneurysms can normally be resolved with lifestyle and diet modifications.

Question 16.16. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?(Points : 0.4)

Increased preload due to vascular resistance

High afterload because of backpressure against the left ventricle

Impaired contractility due to aortic resistance

Systolic impairment because of arterial stenosis

Question 17.17. 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 18.18. 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)

Pheochromocytoma

Essential hypertension

Coarctation of the aorta

An adrenocortical disorder

Question 19.19. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician.As part of the patient’s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours.Which of the following statements best captures an aspect of Holter monitoring? (Points : 0.4)

A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity.

The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies.

Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording.

Holter monitors are normally set to record electrical activity of the heart at least once per hour.

Question 20.20. 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 21.21. 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 22.22. 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 23.23. 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 24.24. 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 25.25. 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.”

Winland-Brown, J.E. and Dunphy, L.M. (2013). Adult-Gerontology and Family Nurse Practitioner Certification Examination: Review Questions and Strategies.

Codina Leik, M.T. (2013). Adult-Gerotonolgy Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions. 2ND Ed.

Chamberlian NR507 final exam 2016 (Score 100%)

Question

1. Question : Continued therapy of pernicious anemia (PA) generally lasts how long?

6 to 8 weeks

8 to 12 months

Until the iron level is normal

The rest of one’s life

Question 2. : What pulmonary defense mechanism propels a mucous blanket that entraps particles moving toward the oropharynx?

Nasal turbinates

Alveolar macrophages

Cilia

Irritant receptors on the nares

Question 3. : The common hay fever allergy is expressed through a reaction that is mediated by which class of immunoglobulins?

IgE

IgG

IgM

T cells

Question 4. : Which of the following describes how the body compensates for anemia?

Increasing rate and depth of breathing

Decreasing capillary vasoconstriction

Hemoglobin holding more firmly onto oxygen

Kidneys releasing more erythropoietin

Question 5. : Obesity creates a greater risk for dehydration in people because:

Adipose cells contain little water because fat is water repelling.

The metabolic rate of obese adults is slower than the rate of lean adults.

The rate of urine output of obese adults is higher than the rate of output of lean adults.

The thirst receptors of the hypothalamus do not function effectively.

Question 6. : Which hormone prompts increased anxiety, vigilance, and arousal during a stress response?

Norepinephrine

Epinephrine

Cortisol

Adrenocorticotropic hormone (ACTH)

Question 7. : What is the treatment of choice for pernicious anemia (PA)?

Cyanocobalamin by oral intake

Vitamin B12 by injection

Ferrous fumarate by Z-track injection

Folate by oral intake

Question 8. : Which sexually transmitted infection frequently coexists with gonorrhea?

Syphilis

Herpes simplex virus

Chlamydia

Chancroid

Question 9. : During an infection, why do lymph nodes enlarge and become tender?

B lymphocytes proliferate.

The nodes are inflamed.

The nodes fill with purulent exudate.

The nodes are not properly functioning.

Question 10. : Chvostek and Trousseau signs indicate which electrolyte imbalance?

Hypokalemia

Hyperkalemia

Hypocalcemia

Hypercalcemia

Question 11. : What is the suggested mean blood pressure for an 8- to 9-year-old child?

104/55 mm Hg

106/58 mm Hg

112/62 mm Hg

121/70 mm Hg

Question 12. : Stress-induced sympathetic stimulation of the adrenal medulla causes the secretion of:

Epinephrine and aldosterone

Norepinephrine and cortisol

Epinephrine and norepinephrine

Acetylcholine and cortisol

Question 13. : Bronchiolitis tends to occur during the first years of life and is most often caused by what type of infection?

Respiratory syncytial virus (RSV)

Influenzavirus

Adenoviruses

Rhinovirus

Question 14. : What is the function of erythrocytes?

Tissue oxygenation

Hemostasis

Infection control

Allergy response

Question 15. : The tonic neck reflex observed in a newborn should no longer be obtainable by:

2 years

1 year

10 months

5 months

Question 16. Where are Kupffer cells located?

Kidneys

Liver

Pancreas

Spleen

Question 17. Stress-induced norepinephrine results in:

Pupil constriction

Peripheral vasoconstriction

Increased sweat gland secretions

Decreased blood pressure

Question 18. Which normal physiologic change occurs in the aging pulmonary system?

Decreased flow resistance

Fewer alveoli

Stiffening of the chest wall

Improved elastic recoil

Question 19. Which statement accurately describes childhood asthma?

An obstructive airway disease characterized by reversible airflow obstruction, bronchial hyperreactivity, and inflammation

A pulmonary disease characterized by severe hypoxemia, decreased pulmonary compliance, and diffuse densities on chest x-ray imaging

A pulmonary disorder involving an abnormal expression of a protein, producing viscous mucus that lines the airways, pancreas, sweat ducts, and vas deferens

An obstructive airway disease characterized by atelectasis and increased pulmonary resistance as a result of a surfactant deficiency

Question 20. In which structure does B lymphocytes mature and undergo changes that commit them to becoming B cells?

Thymus gland

Regional lymph nodes

Bone marrow

Spleen

Question 21. Tissue damage caused by the deposition of circulating immune complexes containing an antibody against the host DNA is the cause of which disease?

Hemolytic anemia

Pernicious anemia

Systemic lupus erythematosus

Myasthenia gravis

Question 22. Where are Langerhans cells found?

Skin

Intestinal lining

Kidney

Thyroid

Question 23. What is the most commonly reported symptom of cancer treatment?

Nausea

Fatigue

Hair loss

Weight loss

Question 24. Cystic fibrosis is caused by which process?

Autosomal recessive inheritance

Autosomal dominant inheritance

Infection

Malignancy

Question 25. What is the primary cause of the symptoms of polycythemia vera?

Decreased erythrocyte count

Destruction of erythrocytes

Increased blood viscosity

Neurologic involvement

Question 26. What term is used to describe a hernial protrusion of a saclike cyst that contains meninges, spinal fluid, and a portion of the spinal cord through a defect in a posterior arch of a vertebra?

Encephalocele

Meningocele

Spina bifida occulta

Myelomeningocele

Question 27. How is the effectiveness of vitamin B12 therapy measured?

Reticulocyte count

Serum transferring

Hemoglobin

Serum vitamin B12

Question 28. The ability of the pathogen to invade and multiply in the host is referred to as:

Infectivity

Toxigenicity

Pathogenicity

Virulence

Question 29. Which is an example of an endogenous antigen?

Yeast

Cancer cells

Bacteria

Fungus

Question 30. Which immunoglobulin is present in blood, saliva, breast milk, and respiratory secretions?

IgA

IgE

IgG

IgM

Question 31. Which blood cells are the chief phagocytes involved in the early inflammation process?

Neutrophils

Monocytes

Eosinophils

Erythrocytes

Question 32. Which renal change is found in older adults?

Sharp decline in glomerular filtration rate

Sharp decline in renal blood flow

Decrease in the number of nephrons

Decrease in urine output

Question 33. A hypersensitivity reaction that produces an allergic response is called:

Hemolytic shock

Anaphylaxis

Necrotizing vasculitis

Systemic erythematosus

Question 34. What period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated?

Refractory

Hyperpolarization

Threshold

Sinoatrial (SA)

Question 35. What is the most common predisposing factor to obstructive sleep apnea in children?

Chronic respiratory infections

Adenotonsillar hypertrophy

Obligatory mouth breathing

Paradoxic breathing

Question 36. Kidney stones in the upper part of the ureter would produce pain referred to which anatomical area?

Vulva or penis

Umbilicus

Thighs

Lower abdomen

Question 37. Aspiration is most likely to occur in the right mainstem bronchus because it:

Extends vertically from the trachea.

Is narrower than the left mainstem bronchus.

Comes into contact with food and drink first.

Is located at the site where the bronchi bifurcate.

Question 38. Blood cells that differentiate into macrophages are known as:

Monocytes

Neutrophils

Eosinophils

Basophils

Question 39. What characteristic do atopic individuals have that make them genetically predisposed to develop allergies?

Greater quantities of histamine

More histamine receptors

Greater quantities of IgE

A deficiency in epinephrine

Question 40. Pressure in the left ventricle must exceed pressure in which structure before the left ventricle can eject blood?

Superior vena cava

Aorta

Inferior vena cava

Pulmonary veins

Question 41. How does chest wall compliance in an infant differ from that of an adult?

An adult’s chest wall compliance is lower than an infant’s.

An adult’s chest wall compliance is higher than an infant’s.

An adult’s chest wall compliance is the same as an infant’s.

An adult’s chest wall compliance is dissimilar to that of an infant’s.

Question 42. In a full-term infant, the normal erythrocyte life span is _____ days, whereas the adult erythrocyte life span is _____ days.

30 to 50; 80

60 to 80; 120

90 to 110; 140

120 to 130; 150

Question 43. Which type of microorganism reproduces on the skin?

Viruses

Bacteria and fungi

Protozoa and Rickettsiae

Mycoplasma

Question 44. An infant diagnosed with a small patent ductus arteriosus (PDA) would likely exhibit which symptom?

Intermittent murmur

Lack of symptoms

Need for surgical repair

Triad of congenital defects

Question 45. Oxygenated blood flows through which vessel?

Superior vena cava

Pulmonary veins

Pulmonary artery

Coronary veins

Question 46. : Why is the herpes virus inaccessible to antibodies after the initial infection?

The virus does not circulate in the blood.

It does not have antibody receptors.

It resists agglutination.

The virus is a soluble antigen.

Question 47. What type of immunity is produced when an immunoglobulin crosses the placenta?

Passive-acquired immunity

Active-acquired immunity

Passive-innate immunity

Active-innate immunity

Question 48. The concentration of the final urine is determined by antidiuretic hormone (ADH), which is secreted by which gland?

Posterior pituitary

Thyroid

Parathyroid

Anterior pituitary

Question 49. Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is notsuccessful?

Flight or fight

Alarm

Adaptation

Arousal

Question 50. When the maternal immune system becomes sensitized against antigens expressed by the fetus, what reaction occurs?

T-cell immunity

Alloimmunity

Fetal immunity

Autoimmunity

Question 51. Which bones are affected in Legg-Calvé-Perthes disease?

Heads of the femur

Distal femurs

Heads of the humerus

Distal tibias

Question 52. What is the basic structural unit in compact bone?

Small channels called canaliculi

Osteocytes within the lacunae

Tiny spaces within the lacunae

Haversian system

Question 53. Which type of fracture usually occurs in an individual who engages in a new activity that is strenuous and repetitive?

Stress

Greenstick

Insufficiency

Pathologic

Question 54. Antipsychotic drugs block which neurotransmitter receptor?

Norepinephrine

Gamma-aminobutyric acid

Serotonin

Dopamine

Question 55. Which risk factor for hypertension is influenced by genetic factors and lifestyle?

Sodium intake

Physical inactivity

Psychosocial stress

Obesity

Question 56. : Where is oxytocin synthesized?

Hypothalamus

Paraventricular nuclei

Anterior pituitary

Posterior pituitary

Question 57. An insufficient dietary intake of which vitamin can lead to rickets in children?

C

B12

B6

D

Question 58. When insulin binds its receptors on muscle cells, an increase in glucose uptake by the muscle cells is the result. This is an example of what type of effect by a hormone?

Pharmacologic

Permissive

Synergistic

Direct

Question 59. Thyroid-stimulating hormone (TSH) is released to stimulate thyroid hormone (TH) and is inhibited when plasma levels of TH are adequate. This is an example of:

Positive feedback

Negative feedback

Neural regulation

Physiologic regulation

Question 60. At 2 or 3 weeks of age, an infant who has been well fed and has gained weight begins to vomit for no apparent reason. The vomiting gradually becomes more forceful. These symptoms may be indicative of which disorder?

Esophageal atresia

Congenital aganglionic megacolon

Pyloric stenosis

Galactosemia

Question 61. Neurofibrillary tangles characterize which neurologic disorder?

Dementia syndrome

Delirium

Alzheimer disease

Parkinson disease

Question 62. What is the target tissue for prolactin-releasing factor?

Hypothalamus

Anterior pituitary

Mammary glands

Posterior pituitary

Question 63. A child with which genetic disorder has a characteristic cry?

Down syndrome

Klinefelter syndrome

Turner syndrome

Cri du chat

Question 64. Which structure attaches skeletal muscle to bone?

Tendon

Ligament

Bursa

Mesentery

Question 65. Which condition poses the highest risk for a cerebrovascular accident (CVA)?

Insulin-resistant diabetes mellitus

Hypertension

Polycythemia

Smoking

Question 66. Which type of diarrhea results from lactose intolerance?

Secretory

Motility

Osmotic

Small volume

Question 67. The most critical aspect in correctly diagnosing a seizure disorder and establishing its cause is:

Computed tomographic (CT) scan

Cerebrospinal fluid analysis

Skull x-ray studies

Health history

Question 68. Which medical diagnosis is characterized by tissue degeneration or irritation of the extensor carpi radialis brevis tendon?

Lateral epicondylitis

Medial tendinitis

Bursitis

Lateral tendinitis

Question 69. Which change is a result of puberty and defends the vagina from infection?

The pH stabilizes between 7 and 8.

A thin squamous epithelial lining develops.

Vaginal pH becomes more acidic.

Estrogen levels are low.

Question 70. The number of persons living with a specific disease at a specific point in time is referred to by which term?

Relativity

Survivability

Prevalence

Incidence

Question 71. : Which hormone is involved in the regulation of serum calcium levels?

Parathyroid hormone (PTH)

Thyroxine (T4)

Adrenocorticotropic hormone (ACTH)

Triiodothyronine (T3)

Question 72. : The secretion of adrenocorticotropic-stimulating hormone (ACTH) will result in the increased level of which hormone?

Thyroxine

Insulin

Cortisol.

Antidiuretic hormone

Question 73. : What happens to the vagina’s lining at puberty?

It becomes thinner.

It becomes thicker.

It assumes a neutral pH.

It undergoes atrophy.

Question 74. : In 95% of children of delayed puberty, the problem is caused by:

Disruption in the hypothalamus

Disruption of the pituitary

Deficit in estrogen or testosterone

Physiologic hormonal delays

Question 75. : Adoption studies have shown that the offspring of an alcoholic parent when raised by nonalcoholic parents have what amount of an increased risk of developing alcoholism?

Twofold

Threefold

Fourfold

Tenfold

Question 76. : What directly causes ovulation during the menstrual cycle?

Gradual decrease in estrogen levels

Sudden increase of LH

Sharp rise in progesterone levels

Gradual increase in estrogen levels

Question 77. : The major sleep center is located in which section of the brain?

Thalamus

Brainstem

Frontal lobe

Hypothalamus

Question 78. : What is the second most commonly recognized genetic cause of mental retardation?

Down syndrome

Fragile X syndrome

Klinefelter syndrome

Turner syndrome

Question 79. : Which person is at the greatest risk for developing delirium?

An individual with diabetes celebrating a 70th birthday

A depressed Hispanic woman

An individual on the second day after hip replacement

A man diagnosed with schizophrenia

Question 80. : Which hormone triggers uterine contractions?

Thyroxine

Oxytocin

Growth hormone

Insulin

Question 81. Question : What is the risk for the recurrence of autosomal dominant diseases?

10%

30%

50%

70%

Question 82. : A person with 47, XXY karyotype has the genetic disorder resulting in which syndrome?

Turner

Klinefelter

Down

Fragile X

Question 83. : The failure of bones to ossify, resulting in soft bones and skeletal deformity, characterizes which disorder?

Osteogenesis imperfecta

Rickets

Osteochondrosis

Legg-Calvé-Perthes disease

Question 84. : What effect does hyperphosphatemia have on other electrolytes?

Increases serum calcium.

Decreases serum calcium.

Decreases serum magnesium.

Increases serum magnesium.

Question 85. : What term is used to identify an interlacing bundle of dense, white fibrous tissue that is richly supplied with nerves, blood vessels, and lymphatic vessels?

Procallus

Joint capsule

Hematoma

Elastin fibers

Question 86. : Where is the usual site of cervical dysplasia or cancer in situ?

Squamous epithelium of the cervix meets the cuboidal epithelium of the vagina.

Columnar epithelium of the cervix meets the squamous epithelium of the uterus.

Squamous epithelium of the cervix meets the columnar epithelium of the uterus.

Columnar epithelium of the cervix meets the squamous epithelium of the vagina.

Question 87. : What is the most common malignant bone tumor diagnosed during childhood?

Chondrosarcoma

Fibrosarcoma

Ewing Sarcoma

Osteosarcoma

Question 88. Question : Obesity acts as an important risk factor for type 2 diabetes mellitus by:

Reducing the amount of insulin the pancreas produces

Increasing the resistance to insulin by cells

Obstructing the outflow of insulin from the pancreas

Stimulating the liver to increase glucose production

Question 89. What is the cause of familial hypercholesterolemia (FH)?

Diet high in saturated fats

Increased production of cholesterol by the liver

Reduction in the number of low-density lipoprotein (LDL) receptors on cell surfaces

Abnormal function of lipoprotein receptors circulating in the blood

Question 90. How do the clinical manifestations and onset of juvenile rheumatoid arthritis (JRA) differ from those of rheumatoid arthritis (RA) in adults?

JRA begins insidiously with systemic signs of inflammation.

JRA predominantly affects large joints.

JRA has more severe joint pain than adult RA.

JRA has a rapid onset of generalized aches as the first symptom.

Question 91. Question : Which clinical manifestations are associated with fibromyalgia?

Hot, tender, and edematous muscle groups bilaterally

Fasciculations of the upper and lower extremity muscles

Exercise intolerance and painful muscle cramps

Sensitivity at tender points and profound fatigue

Question 92. Question : Parkinson disease is a degenerative disorder of the brain’s:

Hypothalamus

Anterior pituitary

Frontal lobe

Basal ganglia

Question 93. Open-angle glaucoma occurs because of:

Decreased production of aqueous humor

Increased production of vitreous humor

Obstructed outflow of aqueous humor

Excessive destruction of vitreous humor

Question 94. Question : A complex partial seizure is described as:

Alternating of tonic and clonic movements

Impairment of both consciousness and the ability to react to exogenous stimuli

Focal motor movement without loss of consciousness

One seizure followed by another in less than 1 minute

Question 95. Why is prolonged diarrhea more severe in children than it is in adults?

Less water is absorbed from the colon in children.

Fluid reserves are smaller in children.

Children have a higher fluid volume intake.

Children have diarrhea more often than adults.

Question 96. Question : What is the blood type of a person who is heterozygous, having A and B alleles as codominant?

A

B

O

AB

Question 97. Question : The mucosal secretions of the cervix secrete which immunoglobulin?

IgA

IgE

IgG

IgM

Question 98. Question : Which clinical manifestations would be expected for a child who has complete trisomy of the twenty-first chromosome?

Widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair

An IQ of 25 to 70, low nasal bridge, protruding tongue, and flat, low-set ears

High-pitched voice, tall stature, gynecomastia, and an IQ of 60 to 90

Circumoral cyanosis, edema of the feet, short stature, and mental slowness

Question 99. Dilation of the ipsilateral pupil, following uncal herniation, is the result of pressure on which cranial nerve (CN)?

Optic (CN I)

Abducens (CN VI)

Oculomotor (CN III)

Trochlear (CN IV)

Question 100. Question : A criterion for a diagnosis of generalized anxiety disorder (GAD) is a period of excessive worrying that lasts for at least how many months?

3

6

9

12

nr507 Week 3 quiz 2016 (Score 100%)

Question

Question 1.1. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician. As part of the patient’s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring? (Points : 0.4)

A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity.

The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies.

Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording.

Holter monitors are normally set to record electrical activity of the heart at least once per hour.

Question 2.2. 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 3.3. 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 4.4. 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)

Pheochromocytoma

Essential hypertension

Coarctation of the aorta

An adrenocortical disorder

Question 5.5. 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 6.6. 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 7.7. 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 8.8. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient’s most likely diagnosis? (Points : 0.4)

Hypovolemic shock

Septic shock

Neurogenic shock

Obstructive shock

Question 9.9. 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)

Signal-averaged ECG

Exercise stress testing

Electrophysiologic study

Holter monitoring

Question 10.10. A nurse practitioner is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor? (Points : 0.4)

A 61-year-old man who has a heart valve infection and recurrent fever

An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness

A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week

A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

Question 11.11. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?(Points : 0.4)

Increased preload due to vascular resistance

High afterload because of backpressure against the left ventricle

Impaired contractility due to aortic resistance

Systolic impairment because of arterial stenosis

Question 12.12. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)

A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort

A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin

A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

Question 13.13. 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

Question 14.14. An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner’s choice of blood work? (Points : 0.4)

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology.

BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.

BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.

BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

Question 15.15. 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 16.16. 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 17.17. 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 18.18. 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 19.19. 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 20.20. 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 21.21. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms.Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? (Points : 0.4)

Aneurysms are commonly a result of poorly controlled diabetes mellitus.

Hypertension is a frequent modifiable contributor to aneurysms.

Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures.

Aneurysms can normally be resolved with lifestyle and diet modifications.

Question 22.22. 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 23.23. 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 24.24. An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0.4)

An increase in preload via the Frank-Starling mechanism

Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine

Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP)

AV node pacemaking activity and vagal nerve suppression

Question 25.25. 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.

1. A nurse practitioner is teaching a student NP about the physiologic basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by the student would warrant correction by the nurse practitioner? (Points : 0.4)

“As vessel wall thickness increases, tension decreases.”

“Smaller blood vessels require more pressure to overcome wall tension.”

“The smaller the vessel radius, the greater the pressure needed to keep it open.”

“Tension and vessel thickness increase proportionately.”

Question 2.2. 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)

Signal-averaged ECG

Exercise stress testing

Electrophysiologic study

Holter monitoring

Question 3.3. 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 4.4. An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0.4)

An increase in preload via the Frank-Starling mechanism

Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine

Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP)

AV node pacemaking activity and vagal nerve suppression

Question 5.5. 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 6.6. 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 7.7. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)

A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort

A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin

A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

Question 8.8. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient’s most likely diagnosis? (Points : 0.4)

Hypovolemic shock

Septic shock

Neurogenic shock

Obstructive shock

Question 9.9. 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

Question 10.10. An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner’s choice of blood work? (Points : 0.4)

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology.

BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.

BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.

BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

Question 11.11. 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.

Question 12.12. 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 13.13. Which of the following situations related to the transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? (Points : 0.4)

Pressure in the pulmonary circulation and the right side of the infant’s heart fall markedly.

Alveolar oxygen tension increases, causing reversal of pulmonary vasoconstriction of the fetal arteries.

Systemic vascular resistance and left ventricular pressure are both increasing.

Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant’s first week.

Question 14.14. 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 15.15. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms.Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? (Points : 0.4)

Aneurysms are commonly a result of poorly controlled diabetes mellitus.

Hypertension is a frequent modifiable contributor to aneurysms.

Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures.

Aneurysms can normally be resolved with lifestyle and diet modifications.

Question 16.16. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?(Points : 0.4)

Increased preload due to vascular resistance

High afterload because of backpressure against the left ventricle

Impaired contractility due to aortic resistance

Systolic impairment because of arterial stenosis

Question 17.17. 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 18.18. 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)

Pheochromocytoma

Essential hypertension

Coarctation of the aorta

An adrenocortical disorder

Question 19.19. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician.As part of the patient’s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours.Which of the following statements best captures an aspect of Holter monitoring? (Points : 0.4)

A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity.

The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies.

Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording.

Holter monitors are normally set to record electrical activity of the heart at least once per hour.

Question 20.20. 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 21.21. 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 22.22. 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 23.23. 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 24.24. 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 25.25. 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.”

Winland-Brown, J.E. and Dunphy, L.M. (2013). Adult-Gerontology and Family Nurse Practitioner Certification Examination: Review Questions and Strategies.

Codina Leik, M.T. (2013). Adult-Gerotonolgy Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions. 2ND Ed.

Punnet square

In dog, long ears and droopy ears are dominant traits, while short ears and point ears are recessive traits. Cross a heterozygous long, homozygous droopy eared dog with a heterozygous long, homozygous pointy eared dog

GBIO 225 WEEK 8 EXAM (ALL ARE CORRECT)

1) Charles Darwin

(2pts)

studied to become a doctor.

is identified with the concept of natural selection.

lived in New England..

followed his avocation as a sailor.

2) The word evolution, as used in biology, literally means

(2pts)

genetic change.

natural selection.

divergence.

genetic drift.

3) Microevolution is the result of all of the following EXCEPT

(2pts)

chance variation.

mutation.

large scale patterns or trends.

change in gene frequency.

4) Natural selection operates to produce changes in

(2pts)

phyla.

populations.

races.

individuals.

5) The trait of connected earlobes is considered a

(2pts)

beneficial trait.

neutral trait.

harmful trait.

dominant trait.

6) The great apes and first hominids arose from a common ancestor approximately ____ years ago.

(2pts)

5 million

7 million

1 million

100,000

7) The total number of individuals in a given area of habitat is the

(2pts)

population growth.

population density.

population birth rate.

population size.

8) The rate of increase for a population refers to what kind of relationship between birth rate and death rate?

(2pts)

the doubling time between them

their sum

the difference between them

their sum

9) The growth rate

(2pts)

is controlled by the frequency of assisted reproduction.

does not vary from one species to another.

is controlled best through non-biological mechanisms.

is controlled by the number of offspring produced.

10) Fresh water and forests may be tapped indefinitely as long as they’re replenished. They are classified as

(2pts)

renewable resources.

biogeographical resources.

nonrenewable resources.

ecological sources.

11) In brown air fog, which substance combines with nitrogen dioxide in the sunlight to form photochemical smog?

(2pts)

water vapor

hydrocarbons

sulfuric acid

carbon monoxide

12) Which gasses are considered “greenhouse gasses”?

(2pts)

carbon dioxide

ozone

nitrous oxide

all of these

13) A benefit of global warming includes

(2pts)

farming in areas that were too cold in the past.

more open shipping channels in the Arctic.

commercial fishing in the Arctic ocean.

all of these

14) Serious detrimental affects of global warming include

(2pts)

intense rains and flooding.

more frequent and intense droughts.

the disappearance of glaciers thus wiping out some fresh water supplies.

all of these

15) The primary cause of desertification in the world today is

(2pts)

clearing and degradation of tropical forests.

overgrazing of marginal lands.

herbicide and fertilizer runoff.

increased salinity resulting from irrigation practices.

Pick a sports movie or book (novel or biography) that illustrates one of the topics discussed so far on the course (the pursuit of excellence, the urge to win, fair play, sport as beauty, sport as tra

Pick a sports movie or book (novel or biography) that illustrates one of the topics discussed so far on the course (the pursuit of excellence, the urge to win, fair play, sport as beauty, sport as tragedy, sport as religion, etc). Describe the plot or key features of the book or movie where necessary, but focus on explaining how it illustrates the dimension of sport you are exploring. Finally, state how you think the movie/book deepens our understanding of sport in the area you are discussing. Wherever possible, use the readings from the class to explain and illustrate your points.  (Note: this is NOT a book report/movie review: only describe plot/characters as necessary for discussing the philosophical issue.)  25 points, 3 pages. Deadline: Sunday 11:59pm

To give you one example: this week we have talked about sport in terms of sacred places and in terms of camaraderie or solidarity. You could choose a movie or novel that contains what you consider to be an example of these, and then explore how the movie or book illustrates and deepens your understanding of this aspect of sport.

Some examples of books/movies and how to write about them: 

The film Jerry Maguire: The role of agents in sport, the place of money and whether it should be a key motivating factor in sport, the ethical status of greed. What the film implies about this issue, and your own opinion or response to that.

Biography of Roger Bannister (first man to run a sub 4-minute mile): the psychology of an athlete; why he runs; the impact of the athlete as role model. 

Nick Hornby, novel ‘Fever Pitch’, about a soccer-mad fan: The life of a sports fan, its drawbacks and joys. Discussion of whether being a sports fan is worth it, and the advantages of this lifestyle.

These are just some suggestions, and for whatever item you choose multiple issues will be touched upon – it’s best to just focus on one as it’s a short paper and depth of analysis is what I’m looking for. 

nr507 Week 3 quiz 2016 (Score 100%)

Question

Question 1.1. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician. As part of the patient’s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring? (Points : 0.4)

A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity.

The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies.

Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording.

Holter monitors are normally set to record electrical activity of the heart at least once per hour.

Question 2.2. 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 3.3. 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 4.4. 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)

Pheochromocytoma

Essential hypertension

Coarctation of the aorta

An adrenocortical disorder

Question 5.5. 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 6.6. 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 7.7. 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 8.8. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient’s most likely diagnosis? (Points : 0.4)

Hypovolemic shock

Septic shock

Neurogenic shock

Obstructive shock

Question 9.9. 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)

Signal-averaged ECG

Exercise stress testing

Electrophysiologic study

Holter monitoring

Question 10.10. A nurse practitioner is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor? (Points : 0.4)

A 61-year-old man who has a heart valve infection and recurrent fever

An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness

A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week

A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

Question 11.11. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?(Points : 0.4)

Increased preload due to vascular resistance

High afterload because of backpressure against the left ventricle

Impaired contractility due to aortic resistance

Systolic impairment because of arterial stenosis

Question 12.12. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)

A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort

A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin

A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

Question 13.13. 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

Question 14.14. An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner’s choice of blood work? (Points : 0.4)

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology.

BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.

BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.

BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

Question 15.15. 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 16.16. 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 17.17. 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 18.18. 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 19.19. 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 20.20. 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 21.21. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms.Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? (Points : 0.4)

Aneurysms are commonly a result of poorly controlled diabetes mellitus.

Hypertension is a frequent modifiable contributor to aneurysms.

Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures.

Aneurysms can normally be resolved with lifestyle and diet modifications.

Question 22.22. 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 23.23. 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 24.24. An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0.4)

An increase in preload via the Frank-Starling mechanism

Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine

Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP)

AV node pacemaking activity and vagal nerve suppression

Question 25.25. 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.

1. A nurse practitioner is teaching a student NP about the physiologic basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by the student would warrant correction by the nurse practitioner? (Points : 0.4)

“As vessel wall thickness increases, tension decreases.”

“Smaller blood vessels require more pressure to overcome wall tension.”

“The smaller the vessel radius, the greater the pressure needed to keep it open.”

“Tension and vessel thickness increase proportionately.”

Question 2.2. 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)

Signal-averaged ECG

Exercise stress testing

Electrophysiologic study

Holter monitoring

Question 3.3. 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 4.4. An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0.4)

An increase in preload via the Frank-Starling mechanism

Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine

Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP)

AV node pacemaking activity and vagal nerve suppression

Question 5.5. 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 6.6. 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 7.7. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)

A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort

A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin

A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

Question 8.8. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient’s most likely diagnosis? (Points : 0.4)

Hypovolemic shock

Septic shock

Neurogenic shock

Obstructive shock

Question 9.9. 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

Question 10.10. An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner’s choice of blood work? (Points : 0.4)

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology.

BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.

BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.

BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

Question 11.11. 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.

Question 12.12. 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 13.13. Which of the following situations related to the transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? (Points : 0.4)

Pressure in the pulmonary circulation and the right side of the infant’s heart fall markedly.

Alveolar oxygen tension increases, causing reversal of pulmonary vasoconstriction of the fetal arteries.

Systemic vascular resistance and left ventricular pressure are both increasing.

Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant’s first week.

Question 14.14. 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 15.15. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms.Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? (Points : 0.4)

Aneurysms are commonly a result of poorly controlled diabetes mellitus.

Hypertension is a frequent modifiable contributor to aneurysms.

Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures.

Aneurysms can normally be resolved with lifestyle and diet modifications.

Question 16.16. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?(Points : 0.4)

Increased preload due to vascular resistance

High afterload because of backpressure against the left ventricle

Impaired contractility due to aortic resistance

Systolic impairment because of arterial stenosis

Question 17.17. 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 18.18. 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)

Pheochromocytoma

Essential hypertension

Coarctation of the aorta

An adrenocortical disorder

Question 19.19. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician.As part of the patient’s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours.Which of the following statements best captures an aspect of Holter monitoring? (Points : 0.4)

A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity.

The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies.

Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording.

Holter monitors are normally set to record electrical activity of the heart at least once per hour.

Question 20.20. 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 21.21. 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 22.22. 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 23.23. 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 24.24. 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 25.25. 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.”

Winland-Brown, J.E. and Dunphy, L.M. (2013). Adult-Gerontology and Family Nurse Practitioner Certification Examination: Review Questions and Strategies.

Codina Leik, M.T. (2013). Adult-Gerotonolgy Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions. 2ND Ed.

nr507 Week 3 quiz 2016 (Score 100%)

Question

Question 1.1. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician. As part of the patient’s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring? (Points : 0.4)

A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity.

The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies.

Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording.

Holter monitors are normally set to record electrical activity of the heart at least once per hour.

Question 2.2. 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 3.3. 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 4.4. 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)

Pheochromocytoma

Essential hypertension

Coarctation of the aorta

An adrenocortical disorder

Question 5.5. 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 6.6. 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 7.7. 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 8.8. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient’s most likely diagnosis? (Points : 0.4)

Hypovolemic shock

Septic shock

Neurogenic shock

Obstructive shock

Question 9.9. 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)

Signal-averaged ECG

Exercise stress testing

Electrophysiologic study

Holter monitoring

Question 10.10. A nurse practitioner is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor? (Points : 0.4)

A 61-year-old man who has a heart valve infection and recurrent fever

An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness

A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week

A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

Question 11.11. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?(Points : 0.4)

Increased preload due to vascular resistance

High afterload because of backpressure against the left ventricle

Impaired contractility due to aortic resistance

Systolic impairment because of arterial stenosis

Question 12.12. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)

A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort

A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin

A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

Question 13.13. 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

Question 14.14. An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner’s choice of blood work? (Points : 0.4)

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology.

BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.

BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.

BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

Question 15.15. 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 16.16. 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 17.17. 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 18.18. 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 19.19. 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 20.20. 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 21.21. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms.Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? (Points : 0.4)

Aneurysms are commonly a result of poorly controlled diabetes mellitus.

Hypertension is a frequent modifiable contributor to aneurysms.

Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures.

Aneurysms can normally be resolved with lifestyle and diet modifications.

Question 22.22. 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 23.23. 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 24.24. An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0.4)

An increase in preload via the Frank-Starling mechanism

Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine

Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP)

AV node pacemaking activity and vagal nerve suppression

Question 25.25. 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.

1. A nurse practitioner is teaching a student NP about the physiologic basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by the student would warrant correction by the nurse practitioner? (Points : 0.4)

“As vessel wall thickness increases, tension decreases.”

“Smaller blood vessels require more pressure to overcome wall tension.”

“The smaller the vessel radius, the greater the pressure needed to keep it open.”

“Tension and vessel thickness increase proportionately.”

Question 2.2. 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)

Signal-averaged ECG

Exercise stress testing

Electrophysiologic study

Holter monitoring

Question 3.3. 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 4.4. An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure. Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0.4)

An increase in preload via the Frank-Starling mechanism

Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine

Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP)

AV node pacemaking activity and vagal nerve suppression

Question 5.5. 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 6.6. 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 7.7. A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0.4)

A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort

A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin

A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

Question 8.8. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient’s most likely diagnosis? (Points : 0.4)

Hypovolemic shock

Septic shock

Neurogenic shock

Obstructive shock

Question 9.9. 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

Question 10.10. An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests. What is the most accurate rationale for the nurse practitioner’s choice of blood work? (Points : 0.4)

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology.

BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure.

BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.

BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

Question 11.11. 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.

Question 12.12. 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 13.13. Which of the following situations related to the transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? (Points : 0.4)

Pressure in the pulmonary circulation and the right side of the infant’s heart fall markedly.

Alveolar oxygen tension increases, causing reversal of pulmonary vasoconstriction of the fetal arteries.

Systemic vascular resistance and left ventricular pressure are both increasing.

Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant’s first week.

Question 14.14. 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 15.15. During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment. The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms.Which of the following aspects of the pathophysiology of aneurysms would underlie the explanation the nurse provides? (Points : 0.4)

Aneurysms are commonly a result of poorly controlled diabetes mellitus.

Hypertension is a frequent modifiable contributor to aneurysms.

Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures.

Aneurysms can normally be resolved with lifestyle and diet modifications.

Question 16.16. A patient is experiencing impaired circulation secondary to increased systemic arterial pressure. Which of the following statements is the most relevant phenomenon?(Points : 0.4)

Increased preload due to vascular resistance

High afterload because of backpressure against the left ventricle

Impaired contractility due to aortic resistance

Systolic impairment because of arterial stenosis

Question 17.17. 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 18.18. 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)

Pheochromocytoma

Essential hypertension

Coarctation of the aorta

An adrenocortical disorder

Question 19.19. A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician.As part of the patient’s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours.Which of the following statements best captures an aspect of Holter monitoring? (Points : 0.4)

A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity.

The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies.

Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording.

Holter monitors are normally set to record electrical activity of the heart at least once per hour.

Question 20.20. 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 21.21. 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 22.22. 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 23.23. 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 24.24. 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 25.25. 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.”

Winland-Brown, J.E. and Dunphy, L.M. (2013). Adult-Gerontology and Family Nurse Practitioner Certification Examination: Review Questions and Strategies.

Codina Leik, M.T. (2013). Adult-Gerotonolgy Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions. 2ND Ed.

Do right action and happiness always go together – or in other words – will doing the right thing always make you happy? PS: the paper should present your own view about the issue about the issue, you

Do right action and happiness always go together – or in other words – will doing the right thing always make you happy?

PS: the paper should present your own view about the issue about the issue, you may choose a contemporary example to support your point. Should be 300 to 400 words. Should also contain MLA citation: in text. You are not expected to cite any passages in the Vaughn book.