Question 1

The nurse is teaching the anatomy of venous system while counseling a patient of venous insufficiency. What are the important parts of venous system about which the nurse should teach them?

Accepted Answer

The nurse should tell the patient about all the four general areas of the venous system. The venous system is divided into 4 general areas; superficial venous system (subcutaneous veins and the greater and lesser saphenous veins), communicating venous system (perforating veins), deep venous system (tibial, popliteal, femoral and iliac veins), venous valves (in all infra-inguinal veins).

Question 2

Which of the following sets of medications is used in treatment of Raynaud's disease?

Accepted Answer

Medications used in the treatment of Raynaud's phenomenon include calcium channel blockers to dilate blood vessels, alpha-blockers to counteract the constriction of blood vessels as well as vasodilators to dilate and relax blood vessels.

Question 3

The most common type of cardiomyopathy is:

Accepted Answer

Dilated cardiomyopathy is the most common type of cardiomyopathy. Dilated cardiomyopathy can happen to anyone but is mostly seen in alcoholics and young people.

Question 4

The false statement about stroke is:

Accepted Answer

The false statement about stroke is "Embolic stroke occurs when a blood clot forms in arteries supplying the brain". Ischemic strokes include thrombotic strokes, which occur when a blood clot forms in arteries supplying the brain, and embolic stroke, which occurs when a blood clot (or other embolus, like a cholesterol plaque) formed in the cardiovascular system dislodges and blocks more distal arteries. Hemorrhagic stroke occurs when a blood vessel ruptures and leaks into the brain.

Question 5

Which of the following groups of cells is involved in chronic inflammation?

Accepted Answer

The major cells involved in the chronic inflammation process include monocytes, macrophages, lymphocyte, and plasma cells. These cells are produced in the thymus and bone marrow.

Question 6

Which of the following signaling cascades is not involved in acute inflammation?

Accepted Answer

The phosphatase system is not involved in acute inflammation. The causes of acute inflammation include presence of irritants, pathogens and/or damaged cells within the body. Acute inflammation is characterized by vascular changes including vasodilation, increased permeability, and/or reduced blood flow. The signaling cascades involved in acute inflammation include the complement system such as C3, C5a, membrane attack complex and thrombin, kinin system such as bradykinin, coagulation system such as thrombin and fibrinolysis system such as plasmin.

Question 7

The vascular changes of acute inflammation consist of the following:

Accepted Answer

Acute inflammation is characterized by vascular changes including vasodilation, increased permeability, and/or reduced blood flow. This allows for cytokines and other immune regulators to enter the area of inflammation causing swelling of the tissue.

Question 8

Your patient calls the clinic today because he is taking atorvastatin to treat his high cholesterol and is having pain in both of his legs. You instruct him to:

Accepted Answer

You should instruct him to stop taking the drug immediately and come to the clinic for consultation with the physician today. Muscle aches, soreness, and weakness may be early signs of myopathy such as rhabdomyolysis associated with the HMG-CoA reductase class of antilipemic agents. This patient will need an immediate evaluation to rule out myopathy. Additional doses may exacerbate the problem. Exercise will not reverse myopathy and delays diagnosis.

Question 9

A postoperative surgical patient develops pain, redness, and edema in the calf. These symptoms may potentially indicate which of the following conditions?

Accepted Answer

Pain, redness, and edema in the calf of a postoperative patient indicates thrombophlebitis, resulting from venous stasis. Venous thrombosis (thrombophlebitis) refers to inflammation of a vein precipitating thrombus (blood clot) formation; it almost always occurs in the neck veins or occasionally in the trunk.
Types of venous thrombosis include:
a) Deep Vein Thrombosis (DVT), a stationary clot that forms in the deeper veins of the legs;
b) Superficial thrombophlebitis, an inflammation of a more superficial vein closer to the surface; this condition is accompanied by formation of a stationary clot within the vein. Phlebothrombosis refers to thrombus formation without venous inflammation. Phlebitis refers to inflammation of one or more veins without resultant clot formation. Thrombi formation is believed to occur when both venous stasis and hypercoagulability exist. Stagnated blood will accumulate in the pocket areas of the vessel valves, resulting in hypercoagulability (because activated coagulation factors are not removed from the blood).
Traces of thrombin activate the clotting mechanisms of platelet aggregation and conversion of fibrinogen to fibrin. Trauma or damage to the vessel walls from an injury or phlebitis may cause platelet adhesion to the vein wall. DVT and phlebitis are acute diseases that may result in pulmonary embolism (as pieces of the clot break off and travel to the lung) or chronic venous insufficiency.

Question 10

A 65-year old male with family history of abdominal aortic aneurysm was diagnosed to have aneurysm in the abdominal aorta of 3.5 cm diameter during routine screening. The nurse is explaining to this patient about the regular follow up. What should be explained to the patient by the attending nurse?

Accepted Answer

The nurse should explain to the patient that his aneurysm is not very large and does not need surgical correction at this stage. He should undergo regular follow up on a yearly basis. Risk factor modification may help to retard the progression of aneurysm. For patients with an abdominal or thoracic aortic aneurysm with a diameter less than 3 cm without symptoms, follow-up screening should be conducted within 5 to 10 years. For patients with an aorta of 3 to 4 cm in diameter, follow-up screening should be performed on a yearly basis.

Question 11

Which of the following set of symptoms is correctly matched with the location of the aneurysm?

Accepted Answer

"Brain - severe headache, blurred vision, pain around eye" symptoms match correctly with the location of the aneurysm. Associated symptoms vary by location of the aneurysm. Aneurysms located closer to the surface of body may present with swelling and pain; however, most aneurysms within the body are asymptomatic. Aneurysms in the brain can present with symptoms of localized severe headache, intense pressure, nausea and vomiting, neck pain, blurred or double vision, pain in or around the eye, dilated pupils, sensitivity to light, and loss of sensation. Aneurysms in the abdomen may present with a deep dull penetrating pain in the lower back or abdomen that lasts for days to hours. Signs and symptoms of a peripheral aneurysm may include leg or arm cramping, coldness, and numbness or tingling in the feet due to blocked flow to the peripheral arteries.

Question 12

Which of the following statements is not true about ventricular fibrillation?

Accepted Answer

The statement not true about ventricular fibrillation is that "Ventricular fibrillation is a common arrhythmia which may be present in healthy individuals". Ventricular fibrillation is a serious medical condition that should be treated as a medical emergency. Individuals with an acute ventricular fibrillation episode typically present by fainting or suddenly collapsing and/or becoming unconscious. They also typically present with very rapid or undetectable heart rate. The prognosis of patients who experience ventricular fibrillation depends on the length of time the patient was in fibrillation. However, for those patients who survive an acute ventricular fibrillation episode, the survival rate averages between 2% to 25% post hospital stay.

Question 13

Which of the following cardiac arrhythmias is most serious, and for which emergency defibrillation is often necessary to prevent sudden death?

Accepted Answer

Ventricular fibrillation is the most serious arrhythmia among these and emergency defibrillation is often necessary to prevent sudden death. Ventricular fibrillation is an emergency condition that requires immediate attention and emergency defibrillation is often necessary to prevent serious complications like congestive heart failure and sudden death.

Question 14

A 35-year male patient, who has been diagnosed to have Wolf-Parkinson-White syndrome, is planned to undergo radiofrequency catheter ablation. He is curious to know if this treatment will cure his condition. What is the most appropriate answer that the nurse can give this patient?

Accepted Answer

The nurse should tell this patient that radiofrequency catheter ablation is the most effective and curative treatment for his condition i.e. Wolff-Parkinson-White syndrome. The most effective and curative treatment of Wolff-Parkinson-White syndrome is radiofrequency catheter ablation. However, surgical destruction of the accessory pathway may be performed and be effective, but radiofrequency catheter ablation is typically the most safe and efficacious curative approach.

Question 15

The nurse is recording pulse of a patient admitted in intensive care unit after having a myocardial infarction. The nurse observes that the patient is pulse less and the monitor showing a sine-wave pattern. What is the appropriate emergency management in this patient?

Accepted Answer

The appropriate emergency management in this patient is defibrillation. The sine-wave pattern on monitor suggests that this patient is having acute ventricular tachycardia for which emergency defibrillation is necessary. Cardiopulmonary resuscitation (CPR) is also often necessary.

Question 16

Which of the following statements is not true about Wolf-Parkinson-White syndrome?

Accepted Answer

"Wolf-Parkinson-White syndrome is common in elderly patients" is not true about Wolf-Parkinson-White syndrome. Wolf-Parkinson-White syndrome develops because of formation of extra electrical circuits within the heart. Wolf-Parkinson-White syndrome is the most common cause of tachycardia in young children, toddlers, and infants. The syndrome is more common in men than women, with 60% to 70% of cases in men. However, the syndrome can occur in individuals of all ages and ethnic/racial descents. The highest incidence occurs in individuals between the ages of 30 to 40.

Question 17

Choose the statement which is correct about intermittent claudication:

Accepted Answer

The correct statement about intermittent claudication is "Intermittent claudication is defined as pain in muscles during physical activity which resolves once activity is stopped". The condition is defined as muscle pain or cramping in appendages triggered by walking and physical activity. Individuals may also experience ischemic rest pain. The condition occurs after physical exertion and consists of pain during physical activity, which resolves once the activity is stopped. The pain most commonly occurs in the calves, thighs, and/or buttocks.

Question 18

A patient presenting with symptoms of fatigue, severe shortness of breath, swelling of legs, rapid weight gain over last few days and signs of fluid overload presents to emergency department? Which of the following groups of pharmacologic agents should the nurse prepare to give this patient?

Accepted Answer

The nurse should prepare diuretics, ACE inhibitors, digoxin and beta-blockers to give this patient. Pharmacologic agents used for treatment of heart failure include diuretics, ACE inhibitors, digoxin, beta-blockers, calcium channel blockers, anticoagulants, antiarrhythmia agents, antibiotics, and corticosteroids.

Question 19

A 75-year old male patient is being released from the hospital after improving from familial congestive heart failure. His son was anxious to know if the disease can be prevented by lifestyle modification or prophylactic medications. What is the appropriate advice for the nurse to give to the son??

Accepted Answer

The nurse should advise him that in order to decrease disease progression, he should avoid alcohol and drug consumption, avoid smoking, maintain proper blood pressure, eat a diet low in saturated fats and sodium, reduce fluid intake, treat other co-morbidities and maintain an active lifestyle. Individuals having familial congestive heart failure can reduce extent and degree of disease through self-care and proper disease management, although they cannot prevent the onset.

Question 20

Which of the following sets of conditions during pregnancy increases the risk of developing atrial septal defect in fetus?

Accepted Answer

Rubella infection, poorly controlled diabetes, and illicit drug or alcohol abuse during pregnancy increase the risk of developing atrial septal defect in fetus. The following conditions during pregnancy may increase the risk of an offspring having a congenital heart defect such as atrial septal defects:
•Rubella infection
•Poorly controlled diabetes
•Illicit drug and/or alcohol abuse

Quiz 1: Cardiac Medicine