Question 1

Which of the following is not a feature of syndrome X?

Accepted Answer

The feature that is not associated with syndrome X is an angiogram showing severe abnormalities.
Features of syndrome x are:
•Patient has typical symptoms of angina yet has normal angiogram
•May show definite signs of ischemia during exercise testing
•Pathogenesis thought to be due to inadequate vasodilator reserve of coronary resistance vessels
•Has better prognosis than patient with overt atherosclerotic disease

Question 2

Which of the following malformation is present in transposition of the great arteries (TGA)?

Accepted Answer

The malformation present in transposition of the great arteries (TGA) is characterized by the aorta arising anteriorly from the right ventricle and the pulmonary artery arising posteriorly from the left ventricle. Gestational diabetes mellitus of an expectant mother is a risk factor that has been described for the fetus having TGA.

Question 3

A child has been diagnosed with transposition of great arteries. His parents are curious to know that which surgical method is appropriate for their child. Which of the procedure should the nurse mention as procedure of choice to the parents?

Accepted Answer

The nurse should mention arterial switch operation as the procedure of choice for correction of transposition of great arteries. Balloon septostomy is done for initial palliation. Arterial switch operation is operation of choice since Mustard and Senning operations are associated with RV dysfunction and atrial dysrhythmias.

Question 4

Which of the following correctly represents the pathophysiologic mechanism behind development of cor pulmonale?

Accepted Answer

The pathophysiologic mechanism behind development of cor pulmonale include pulmonary vasoconstriction, compromise of vascular bed due to lung disease such as emphysema and interstitial lung disease, increased blood viscosity due to diseases like sickle cell anemia and primary pulmonary hypertension. Cor pulmonale is an enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lungs.

Question 5

Which of the following is not a correct match with its class of drugs?

Accepted Answer

Diuretic - Metoprolol is not the correct match. Metoprolol is a beta-blocker. The classes of agents included in cardiac glycosides are digitalis, digitoxin, and digoxin; phosphodiesterase inhibitors are amrinone and milrinone; and sympathomimetics are dopamine, dobutamine, isoproterenol, metaraminol, epinephrine and norepinephrine.

Question 6

The nurse is assisting the cardiologist during percutaneous transluminal coronary angioplasty. Which of the following set of drugs should the nurse keep ready to be administered during the procedure?

Accepted Answer

The nurse should keep the drugs heparin, nitroglycerine and abciximab ready to be used during the procedure. Pharmacologic agents used during percutaneous transluminal coronary angioplasty include heparin, nitroglycerine, and/or glycoprotein IIb/IIIa receptor inhibitor such as abciximab.

Question 7

A nurse is preparing a patient to be released after undergoing percutaneous transluminal coronary angioplasty. Which of the following statements correct follow-up advice given to this patient?

Accepted Answer

The correct statement follow-up advice for this patient is that "cardiac stress testing is to be performed 2-6 months after the procedure". Prior to patient release perform additional physical assessment and laboratory tests such as hematocrit, potassium levels, creatinine levels, and cardiac stress testing to be completed 2-6 months post-procedure.

Question 8

An 80-year old hypertensive male is on regular antihypertensive medication, complaints of dizziness, fatigue, syncope or fainting, mental confusion, and lightheadedness after eating meals. The attending nurse records a postprandial fall in blood pressure. What is the appropriate advice to be given by the nurse to help his condition?

Accepted Answer

The appropriate advice given by the nurse is to tell him to eat small meals low in carbohydrates. Postprandial hypotension is a condition that involves a sudden drop in blood pressure after eating. It typically affects elderly individuals with other cardiovascular comorbid condition or neurological disorders. Symptoms of the condition include dizziness, fatigue, syncope or fainting, mental confusion, and/or lightheadedness. Postprandial hypotension is more common among individuals with high blood pressure or autonomic nervous system disorders. Lifestyle modifications such as eating smaller meals low in carbohydrates more often may reduce symptoms. Also, lowering the dose of blood pressure medications may decrease the onset of postprandial hypotension.

Question 9

A nurse records the blood pressure of a patient of a known endocrine disorder and finds that the patient is hypotensive. Which endocrine disease is unlikely in this patient?

Accepted Answer

Cushing's syndrome is unlikely in a patient with hypotension. The main risk factors and causes of hypotension, as outlined by the American Heart Association, include pregnancy; certain pharmacologic agents such as diuretics, beta-blockers, Parkinson disease drugs, tricyclic antidepressants, sildenafil particularly in combination with nitroglycerine, narcotics and alcohol; cardiac conditions such as bradycardia, cardiac valvular disease, myocardial infarction and congestive heart failure; endocrine problems such as hypothyroidism, hyperthyroidism, Addison disease, hypoglycemia and diabetes; blood loss as from major surgery or severe injury; severe infection; allergic reaction; and nutritional deficiency such as vitamin B 12 and folate deficiency, natural aging and dehydration.

Question 10

A nurse records an EKG of an asymptomatic person coming for routine check-up. After looking at the EKG, which of the following findings might the nurse say that there is nothing wrong with the EKG?

Accepted Answer

After looking at the PR interval of 210 milliseconds, the nurse can say that there is nothing wrong with the EKG. First degree AV block is characterized by prolonged PR interval (greater than 200 millisecond), which can also occur as a normal variant in some individuals.

Question 11

Choose the incorrect statement about pericarditis:

Accepted Answer

The incorrect statement about pericarditis is "pericarditis occurs in almost all patients who experience an acute myocardial infarction". There are 2 types of pericarditis, including acute pericarditis and chronic pericarditis. The condition is more prevalent among men than women between the ages of 20 to 50. Acute pericarditis episodes can last from 1 to 3 weeks. Pericarditis occurs in approximately 15% of individuals that experienced an acute myocardial infarction/heart attack. Approximately 25% to 85% of cases present with no clear reason and are idiopathic in nature.

Question 12

Which of the following groups of drugs is used as inotropic agents?

Accepted Answer

Digoxin, dopamine and milrinone are used as inotropic drugs. The classes of agents included in the inotropic group of drugs include cardiac glycosides such as digitalis, digitoxin, and digoxin; phosphodiesterase inhibitors such as amrinone and milrinone; and sympathomimetics such as dopamine, dobutamine, isoproterenol, metaraminol, epinephrine and norepinephrine.

Question 13

Which of the following diuretics is not correct matched with its class of diuretic?

Accepted Answer

"Thiazide diuretic - amiloride, ethacrynic acid" is not a correct match with its class. The classes of agents included in the diuretic group of pharmacologic agents include thiazide diuretics such as bendroflumethiazide, benzthiazide, chlorothiazide, chlorthalidone, hydrochlorothiazide, hydroflumethiazide, indapamide, methyclothiazide, metolazone, polythiazide, quinethazone and trichlormethiazide; loop diuretics such as bumetanide, ethacrynic acid, furosemide and torsemide; potassium-sparing diuretics such as amiloride, spironolactone, and triamterene; and osmotic diuretics such as glycerine and mannitol.

Question 14

Which of the following class of drugs is classified as inotropic agents?

Accepted Answer

Cardiac glycosides are classified as inotropic agents. The classes of agents included in the inotropic group of drugs include cardiac glycosides such as digitalis, digitoxin, and digoxin; phosphodiesterase inhibitors such as amrinone and milrinone; and sympathomimetics such as dopamine, dobutamine, isoproterenol, metaraminol, epinephrine and norepinephrine.

Question 15

Which of the following is a characteristic feature of syndrome X?

Accepted Answer

Patient presenting with typical symptoms of angina but normal angiogram is a characteristic feature of syndrome X. Angiogram showing severe abnormalities is not a feature of syndrome X.
Features of syndrome X are:
•Patient has typical symptoms of angina yet has normal angiogram
•May show definite signs of ischemia during exercise testing
•Pathogenesis thought to be due to inadequate vasodilator reserve of coronary resistance vessels
•Has better prognosis than patient with overt atherosclerotic disease

Question 16

Which of the following surgical corrections is correctly matched the type of aortic stenosis it is to correct?

Accepted Answer

The correct match is Supravalvular aortic stenosis - patch augmentation of ascending aorta.
Surgical procedures for aortic stenosis:
•Subaortic stenosis relieved by resection of fibrous membrane or myectomy of hypertrophied ventricular septum
•Valvular aortic stenosis relieved by percutaneous balloon valvotomy or valve replacement
•Supravalvular aortic stenosis relieved by patch augmentation of the ascending aorta

Question 17

Which of the following statements correctly describes the mechanism of action of phosphodiesterase inhibitors?

Accepted Answer

The statement "Increases calcium level within myocardial cells" correctly describes the mechanism of action of phosphodiesterase inhibitors. These agents increase cardiac muscle contractions and cardiac output. However, these inhibitors have little impact on heart rate and blood pressure.

Question 18

Which of the following murmurs is not audible while auscultating a patient of aortic regurgitation?

Accepted Answer

Crescendo-decrescendo murmur is not heard in aortic regurgitation.
Murmurs heard in aortic regurgitation:
•Early diastolic decrescendo murmur (EDM) - high-pitched, length correlates with severity, best heard with patient sitting, leaning forward on full expiration
•Systolic ejection murmur - physiologic, high flow murmur in aortic area
•Austin Flint murmur - diastolic rumble at apex, secondary to regurgitant jet on anterior MV leaflet

Question 19

A 28- year old female patient presents with chest pain and dyspnea. The attending nurse observes that she is having pectus excavatum. Which of the valvular heart diseases is most likely present in this patient?

Accepted Answer

The most likely valvular lesion in this patient is mitral valve prolapse. Patients present with atypical chest pain, dyspnea, and hyperventilation associated with pectus excavatum, straight back syndrome, and other musculoskeletal abnormalities.

Question 20

Which of the following devices is capable of performing the functions of defibrillation, cardioversion, anti-tachycardia pacing, and anti-bradycardia pacing?

Accepted Answer

Implantable cardiac defibrillators are capable of defibrillation, cardioversion, anti-tachycardia pacing, and anti-bradycardia pacing. Defibrillation is used for pulseless patients while cardioversion and pacing are used for patients with a pulse.

Quiz 1: Cardiac Medicine