1. Which of the following arteries primarily feeds the anterior wall of the heart?

A. Circumflex artery
B. Internal mammary artery
C. Left anterior descending artery
D. Right coronary artery
2. When do coronary arteries primarily receive blood flow?

A. During inspiration
B. During diastole
C. During expiration
D. During systole
3. Which of the following illnesses is the leading cause of death in the US?

A. Cancer
B. Coronary artery disease
C. Liver failure
D. Renal failure
4. Which of the following conditions most commonly results in CAD?

A. Atherosclerosis
B. DM
C. MI
D. Renal failure
5. Atherosclerosis impedes coronary blood flow by which of the following
mechanisms?

A. Plaques obstruct the vein

B. Plaques obstruct the artery
C. Blood clots form outside the vessel wall
D. Hardened vessels dilate to allow the blood to flow through
6. Which of the following risk factors for coronary artery disease cannot be
corrected?

A. Cigarette smoking
B. DM
C. Heredity
D. HPN
7. Exceeding which of the following serum cholesterol levels significantly
increases the risk of coronary artery disease?
 A. 100 mg/dl
B. 150 mg/dl
C. 175 mg/dl
D. 200 mg/dl
8. Which of the following actions is the first priority care for a client exhibiting
signs and symptoms of coronary artery disease?

A. Decrease anxiety
B. Enhance myocardial oxygenation
C. Administer sublignual nitroglycerin
D. Educate the client about his symptoms
9. Medical treatment of coronary artery disease includes which of the
following procedures?

A. Cardiac catheterization
B. Coronary artery bypass surgery
C. Oral medication administration
D. Percutaneous transluminal coronary angioplasty
10. Prolonged occlusion of the right coronary artery produces an infarction in
which of he following areas of the heart?

A. Anterior
B. Apical
C. Inferior
D. Lateral
11. Which of the following is the most common symptom of myocardial
infarction?

A. Chest pain
B. Dyspnea
C. Edema
D. Palpitations
12. Which of the following landmarks is the corect one for obtaining an apical
pulse?

A. Left intercostal space, midaxillary line

B. Left fifth intercostal space, midclavicular line
C. Left second intercostal space, midclavicular line
D. Left seventh intercostal space, midclavicular line
13. Which of the following systems is the most likely origin of pain the client
describes as knifelike chest pain that increases in intensity with inspiration?

A. Cardiac
B. Gastrointestinal
C. Musculoskeletal
D. Pulmonary
14. A murmur is heard at the second left intercostal space along the left
sternal border. Which valve area is this?

A. Aortic
B. Mitral
C. Pulmonic
D. Tricuspid
15. Which of the following blood tests is most indicative of cardiac damage?

A. Lactate dehydrogenase
B. Complete blood count
C. Troponin I
D. Creatine kinase
16. What is the primary reason for administering morphine to a client with
myocardial infarction?

A. To sedate the client

B. To decrease the client’s pain
C. To decrease the client’s anxiety
D. To decrease oxygen demand on the client’s heart
17. Which of the followng conditions is most commonly responsible for
myocardial infarction?

A. Aneurysm
B. Heart failure
C. Coronary artery thrombosis
D. Renal failure
18. What supplemental medication is most frequently ordered in conjuction
with furosemide (Lasix)?

A. Chloride
B. Digoxin
C. Potassium
 D. Sodium
19. After myocardial infarction, serum glucose levels and free fatty acids are
both increase. What type of physiologic changes are these?

A. Electrophysiologic
B. Hematologic
C. Mechanical
D. Metabolic
20. Which of the following complications is indicated by a third heart sound
(S3)?

A. Ventricular dilation
B. Systemic hypertension
C. Aortic valve malfunction
D. Increased atrial contractions
21. After an anterior wall myocardial infarction, which of the following
problems is indicated by auscultation of crackles in the lungs?

A. Left-sided heart failure

B. Pulmonic valve malfunction
C. Right-sided heart failure
D. Tricuspid valve malfunction
22. Which of the following diagnostic tools is most commonly used to
determine the location of myocardial damage?

A. Cardiac catheterization
B. Cardiac enzymes
C. Echocardiogram
D. Electrocardiogram
23. What is the first intervention for a client experiencing myocardial
infarction?

A. Administer morphine
B. Administer oxygen
C. Administer sublingual nitroglycerin
D. Obtain an electrocardiogram
24. What is the most appropriate nursing response to a myocardial infarction
client who is fearful of dying?

A. “Tell me about your feeling right now.”

 B. “When the doctor arrives, everything will be fine.”
C. “This is a bad situation, but you’ll feel better soon.”
D. “Please be assured we’re doing everything we can to make you feel
better.”
25. Which of the following classes of medications protects the ischemic
myocardium by blocking catecholamines and sympathetic nerve stimulation?

A. Beta-adrenergic blockers
B. Calcium channel blockers
C. Narcotics
D. Nitrates
26. What is the most common complication of a myocardial infarction?

A. Cardiogenic shock
B. Heart failure
C. Arrhythmias
D. Pericarditis
27. With which of the following disorders is jugular vein distention most
prominent?

A. Abdominal aortic aneurysm

B. Heart failure
C. Myocardial infarction
D. Pneumothorax
28. What position should the nurse place the head of the bed in to obtain the
most accurate reading of jugular vein distention?

A. High-fowler’s
B. Raised 10 degrees
C. Raised 30 degrees
D. Supine position
29. Which of the following parameters should be checked before
administering digoxin?

A. Apical pulse
B. Blood pressure
C. Radial pulse
D. Respiratory rate
30. Toxicity from which of the following medications may cause a client to
see a green halo around lights?
 A. Digoxin
B. Furosemide
C. Metoprolol
D. Enalapril
31. Which ofthe following symptoms is most commonly associated with left-
sided heart failure?

A. Crackles
B. Arrhythmias
C. Hepatic engorgement
D. Hypotension
32. In which of the following disorders would the nurse expect to assess
sacral eddema in bedridden client?

A. DM
B. Pulmonary emboli
C. Renal failure
D. Right-sided heart failure
33. Which of the following symptoms might a client with right-sided heart
failure exhibit?

A. Adequate urine output

B. Polyuria
C. Oliguria
D. Polydipsia
34. Which of the following classes of medications maximizes cardiac
performance in clients with heat failure by increasing ventricular contractility?

A. Beta-adrenergic blockers
B. Calcium channel blockers
C. Diuretics
D. Inotropic agents
35. Stimulation of the sympathetic nervous system produces which of the
following responses?

A. Bradycardia
B. Tachycardia
C. Hypotension
D. Decreased myocardial contractility
36. Which of the following conditions is most closely associated with weight
gain, nausea, and a decrease in urine output?

A. Angina pectoris
B. Cardiomyopathy
C. Left-sided heart failure
D. Right-sided heart failure
37. What is the most common cause of abdominal aortic aneurysm?

A. Atherosclerosis
B. DM
C. HPN
D. Syphilis
38. In which of the following areas is an abdominal aortic aneurysm most
commonly located?

A. Distal to the iliac arteries

B. Distal to the renal arteries
C. Adjacent to the aortic branch
D. Proximal to the renal arteries
39. A pulsating abdominal mass usually indicates which of the following
conditions?

A. Abdominal aortic aneurysm

B. Enlarged spleen
C. Gastic distention
D. Gastritis
40. What is the most common symptom in a client with abdominal aortic
aneurysm?

A. Abdominal pain
B. Diaphoresis
C. Headache
D. Upper back pain
41. Which of the following symptoms usually signifies rapid expansion and
impending rupture of an abdominal aortic aneurysm?

A. Abdominal pain
B. Absent pedal pulses
C. Angina
 D. Lower back pain
42. What is the definitive test used to diagnose an abdominal aortic
aneurysm?

A. Abdominal X-ray
B. Arteriogram
C. CT scan
D. Ultrasound
43. Which of the following complications is of greatest concern when caring
for a preoperative abdominal aneurysm client?

A. HPN
B. Aneurysm rupture
C. Cardiac arrythmias
D. Diminished pedal pulses
44. Which of the following blood vessel layers may be damaged in a client
with an aneurysm?

A. Externa
B. Interna
C. Media
D. Interna and Media
45. When assessing a client for an abdominal aortic aneurysm, which area of
the abdomen is most commonly palpated?

A. Right upper quadrant

B. Directly over the umbilicus
C. Middle lower abdomen to the left of the midline
D. Midline lower abdomen to the right of the midline
46. Which of the following conditions is linked to more than 50% of clients
with abdominal aortic aneurysms?

A. DM
B. HPN
C. PVD
D. Syphilis
47. Which of the following sounds is distinctly heard on auscultation over the
abdominal region of an abdominal aortic aneurysm client?

A. Bruit
 B. Crackles
C. Dullness
D. Friction rubs
48. Which of the following groups of symptoms indicated a ruptured
abdominal aneurysm?

A. Lower back pain, increased BP, decreased RBC, increased WBC

B. Severe lower back pain, decreased BP, decreased RBC, increased WBC
C. Severe lower back pain, decreased BP, decreased RBC, decreased WBC
D. Intermittent lower back pain, decreased BP, decreased RBC, increased
WBC
49. Which of the following complications of an abdominal aortic repair is
indicated by detection of a hematoma in the perineal area?

A. Hernia
B. Stage 1 pressure ulcer
C. Retroperitoneal rupture at the repair site
D. Rapid expansion of the aneurysm
50. Which hereditary disease is most closely linked to aneurysm?

A. Cystic fibrosis
B. Lupus erythematosus
C. Marfan’s syndrome
D. Myocardial infarction
51. Which of the following treatments is the definitive one for a ruptured
aneurysm?

A. Antihypertensive medication administration

B. Aortogram
C. Beta-adrenergic blocker administration
D. Surgical intervention
52. Which of the following heart muscle diseases is unrelated to other
cardiovascular disease?

A. Cardiomyopathy
B. Coronary artery disease
C. Myocardial infarction
D. Pericardial Effusion
53. Which of the following types of cardiomyopathy can be associated with
childbirth?
 A. Dilated
B. Hypertrophic
C. Myocarditis
D. Restrictive
54. Septal involvement occurs in which type of cardiomyopathy?

A. Congestive
B. Dilated
C. Hypertrophic
D. Restrictive
55. Which of the following recurring conditions most commonly occurs in
clients with cardiomyopathy?

A. Heart failure
B. DM
C. MI
D. Pericardial effusion
56. What is the term used to describe an enlargement of the heart muscle?

A. Cardiomegaly
B. Cardiomyopathy
C. Myocarditis
D. Pericarditis
57. Dyspnea, cough, expectoration, weakness, and edema are classic signs
and symptoms of which of the following conditions?

A. Pericarditis
B. Hypertension
C. Obliterative
D. Restricitive
58. Which of the following types of cardiomyopathy does not affect cardiac
output?

A. Dilated
B. Hypertrophic
C. Restrictive
D. Obliterative
59. Which of the following cardiac conditions does a fourth heart sound (S4)
indicate?

A. Dilated aorta
 B. Normally functioning heart
C. Decreased myocardial contractility
D. Failure of the ventricle to eject all the blood during systole
60. Which of the following classes of drugs is most widely used in the
treatment of cardiomyopathy?

A. Antihypertensive
B. Beta-adrenergic blockers
C. Calcium channel blockers
D. Nitrates
Answers and Rationales
1. C. Left anterior descending artery. The left anterior descending artery
is the primary source of blood for the anterior wall of the heart. The
circumflex artery supplies the lateral wall, the internal mammary
artery supplies the mammary, and the right coronary artery supplies
the inferior wall of the heart.
2. B. During diastole. Although the coronary arteries may receive a
minute portion of blood during systole, most of the blood flow to
coronary arteries is supplied during diastole. Breathing patterns are
irrelevant to blood flow
3. B. Coronary artery disease. Coronary artery disease accounts for over
50% of all deaths in the US. Cancer accounts for approximately 20%.
Liver failure and renal failure account for less than 10% of all deaths in
the US.
4. A. Atherosclerosis. Atherosclerosis, or plaque formation, is the leading
cause of CAD. DM is a risk factor for CAD but isn’t the most common
cause. Renal failure doesn’t cause CAD, but the two conditions are
related. Myocardial infarction is commonly a result of CAD.
5. B. Plaques obstruct the artery. Arteries, not veins, supply the coronary
arteries with oxygen and other nutrients. Atherosclerosis is a direct
result of plaque formation in the artery. Hardened vessels can’t dilate
properly and, therefore, constrict blood flow.
6. C. Heredity. Because “heredity” refers to our genetic makeup, it can’t
be changed. Cigarette smoking cessation is a lifestyle change that
involves behavior modification. Diabetes mellitus is a risk factor that
can be controlled with diet, exercise, and medication. Altering one’s
diet, exercise, and medication can correct hypertension.
7. D. 200 mg/dl. Cholesterol levels above 200 mg/dl are considered
excessive. They require dietary restriction and perhaps medication.
Exercise also helps reduce cholesterol levels. The other levels listed
 are all below the nationally accepted levels for cholesterol and carry a
lesser risk for CAD.
8. B. Enhance myocardial oxygenation. Enhancing mocardial oxygenation
is always the first priority when a client exhibits signs and symptoms
of cardiac compromise. Without adequate oxygen, the myocardium
suffers damage. Sublingual nitorglycerin is administered to treat acute
angina, but its administration isn’t the first priority. Although
educating the client and decreasing anxiety are important in care
delivery, nether are priorities when a client is compromised.
9. C. Oral medication administration. Oral medication administration is a
noninvasive, medical treatment for coronary artery disease. Cardiac
catheterization isn’t a treatment but a diagnostic tool. Coronary artery
bypass surgery and percutaneous transluminal coronary angioplasty
are invasive, surgical treatments.
10.C. Inferior. The right coronary artery supplies the right ventricle, or the
inferior portion of the heart. Therefore, prolonged occlusion could
produce an infarction in that area. The right coronary artery doesn’t
supply the anterior portion ( left ventricle ), lateral portion ( some of
the left ventricle and the left atrium ), or the apical portion ( left
ventricle ) of the heart.
11.A. Chest pain. The most common symptom of an MI is chest pain,
resulting from deprivation of oxygen to the heart. Dyspnea is the
second most common symptom, related to an increase in the metabolic
needs of the body during an MI. Edema is a later sign of heart failure,
often seen after an MI. Palpitations may result from reduced cardiac
output, producing arrhythmias.
12.B. Left fifth intercostal space, midclavicular line. The correct landmark
for obtaining an apical pulse is the left intercostal space in the
midclavicular line. This is the point of maximum impulse and the
location of the left ventricular apex. The left second intercostal space in
the midclavicular line is where the pulmonic sounds are auscultated.
Normally, heart sounds aren’t heard in the midaxillary line or the
seventh intercostal space in the midclavicular line.
13.D. Pulmonary. Pulmonary pain is generally described by these
symptoms. Musculoskeletal pain only increase with movement.
Cardiac and GI pains don’t change with respiration.
14.C. Pulmonic. Abnormalities of the pulmonic valve are auscultated at the
second left intercostal space along the left sternal border. Aortic valve
abnormalities are heard at the second intercostal space, to the right of
the sternum. Mitral valve abnormalities are heard at the fifth
 intercostal space in the midclavicular line. Tricuspid valve
abnormalities are heard at the third and fourth intercostal spaces
along the sternal border.
15.C. Troponin I. Troponin I levels rise rapidly and are detectable within 1
hour of myocardial injury. Troponin I levels aren’t detectable in people
without cardiac injury. Lactate dehydrogenase is present in almost all
body tissues and not specific to heart muscle. LDH isoenzymes are
useful in diagnosing cardiac injury. CBC is obtained to review blood
counts, and a complete chemistry is obtained to review electrolytes.
Because CK levels may rise with skeletal muscle injury, CK isoenzymes
are required to detect cardiac injury.
16.D. To decrease oxygen demand on the client’s heart. Morphine is
administered because it decreases myocardial oxygen demand.
Morphine will also decrease pain and anxiety while causing sedation,
but isn’t primarily given for those reasons.
17.C. Coronary artery thrombosis. Coronary artery thrombosis causes
occlusion of the artery, leading to myocardial death. An aneurysm is an
outpouching of a vessel and doesn’t cause an MI. Renal failure can be
associated with MI but isn’t a direct cause. Heart failure is usually the
result of an MI.
18.C. Potassium. Supplemental potassium is given with furosemide
because of the potassium loss that occurs as a result of this diuretic.
Chloride and sodium aren’t loss during diuresis. Digoxin acts to
increase contractility but isn’t given routinely with furosemide.
19.D. Metabolic. Both glucose and fatty acids are metabolites whose levels
increase after a myocardial infarction. Mechanical changes are those
that affect the pumping action of the heart, and electro physiologic
changes affect conduction. Hematologic changes would affect the
blood.
20.A. Ventricular dilation. Rapid filling of the ventricles causes
vasodilation that is auscultated as S3. Increased atrial contraction or
systemic hypertension can result is a fourth heart sound. Aortic valve
malfunction is heard as a murmur.
21.A. Left-sided heart failure. The left ventricle is responsible for the most
of the cardiac output. An anterior wall MI may result in a decrease in
left ventricular function. When the left ventricle doesn’t function
properly, resulting in left-sided heart failure, fluid accumulates in the
interstitial and alveolar spaces in the lungs and causes crackles.
Pulmonic and tricuspid valve malfunction causes right-sided heart
failure.
22.D. Electrocardiogram . The ECG is the quickest, most accurate, and
most widely used tool to determine the location of myocardial
infarction. Cardiac enzymes are used to diagnose MI but can’t
determine the location. An echocardiogram is used most widely to
view myocardial wall function after an MI has been diagnosed. Cardiac
catheterization is an invasive study for determining coronary artery
disease and may also indicate the location of myocardial damage, but
the study may not be performed immediately.
23.B. Administer oxygen. Administering supplemental oxygen to the client
is the first priority of care. The myocardium is deprived of oxygen
during an infarction, so additional oxygen is administered to assist in
oxygenation and prevent further damage. Morphine and sublingual
nitroglycerin are also used to treat MI, but they’re more commonly
administered after the oxygen. An ECG is the most common diagnostic
tool used to evaluate MI.
24.A. “Tell me about your feeling right now.”. Validation of the client’s
feelings is the most appropriate response. It gives the client a feeling of
comfort and safety. The other three responses give the client false
hope. No one can determine if a client experiencing MI will feel or get
better and therefore, these responses are inappropriate.
25.A. Beta-adrenergic blockers. Beta-adrenergic blockers work by
blocking beta receptors in the myocardium, reducing the response to
catecholamines and sympathetic nerve stimulation. They protect the
myocardium, helping to reduce the risk of another infarction by
decreasing the workload of the heart and decreasing myocardial
oxygen demand. Calcium channel blockers reduce the workload of the
heart by decreasing the heart rate. Narcotics reduce myocardial
oxygen demand, promote vasodilation, and decreased anxiety. Nitrates
reduce myocardial oxygen consumption by decreasing left ventricular
end-diastolic pressure (preload) and systemic vascular resistance
(afterload).
26.C. Arrhythmias. Arrhythmias, caused by oxygen deprivation to the
myocardium, are the most common complication of an MI. cardiogenic
shock, another complication of MI, is defined as the end stage of left
ventricular dysfunction. The condition occurs in approximately 15% of
clients with MI. Because the pumping function of the heart is
compromised by an MI, heart failure is the second most common
complication. Pericarditis most commonly results from a bacterial of
viral infection but may occur after MI.
27.B. Heart failure. Elevated venous pressure, exhibited as jugular vein
distention, indicates a failure of the heart to pump. Jugular vein
distention isn’t a symptom of abdominal aortic aneurysm or
pneumothorax. An MI, if severe enough, can progress to heart failure;
however, in and of itself, an MI doesn’t cause jugular vein distention.
28.C. Raised 30 degrees. Jugular venous pressure is measured with a
centimeter ruler to obtain the vertical distance between the sternal
angle and the point of highest pulsation with the head of the bed
inclined between 15 and 30 degrees. Inclined pressure can’t be seen
when the client is supine or when the head of the bed is raised 10
degrees because the point that marks the pressure level is above the
jaw (therefore, not visible). In high Fowler’s position, the veins would
be barely discernible above the clavicle.
29.A. Apical pulse. An apical pulse is essential or accurately assessing the
client’s heart rate before administering digoxin. The apical pulse is the
most accurate point in the body. Blood pressure is usually only
affected if the heart rate is too low, in which case the nurse would
withhold digoxin. The radial pulse can be affected by cardiac and
vascular disease and therefore, won’t always accurately depict the
heart rate. Digoxin has no effect on respiratory function.
30.A. Digoxin. One of the most common signs of digoxin toxicity is the
visual disturbance known as the green halo sign. The other
medications aren’t associated with such an effect.
31.A. Crackles. Crackles in the lungs are a classic sign of left-sided heart
failure. These sounds are caused by fluid backing up into the
pulmonary system. Arrhythmias can be associated with both right and
left-sided heart failure. Left-sided heart failure causes hypertension
secondary to an increased workload on the system.
32.D. Right-sided heart failure . The most accurate area on the body to
assed dependent edema in a bedridden client is the sacral area. Sacral,
or dependent, edema is secondary to right-sided heart failure. Diabetes
mellitus, pulmonary emboli, and renal disease aren’t directly linked to
sacral edema.
33.C. Oliguria. Inadequate deactivation of aldosterone by the liver after
right-sided heart failure leads to fluid retention, which causes oliguria.
Adequate urine output, polyuria, and polydipsia aren’t associated with
right-sided heart failure.
34.D. Inotropic agents. Inotropic agents are administered to increase the
force of the heart’s contractions, thereby increasing ventricular
contractility and ultimately increasing cardiac output. Beta-adrenergic
 blockers and calcium channel blockers decrease the heart rate and
ultimately decrease the workload of the heart. Diuretics are
administered to decrease the overall vascular volume, also decreasing
the workload of the heart.
35.B. Tachycardia. Stimulation of the sympathetic nervous system causes
tachycardia and increased contractility. The other symptoms listed are
related to the parasympathetic nervous system, which is responsible
for slowing the heart rate.
36.D. Right-sided heart failure. Weight gain, nausea, and a decrease in
urine output are secondary effects of right-sided heart failure.
Cardiomyopathy is usually identified as a symptom of left-sided heart
failure. Left-sided heart failure causes primarily pulmonary symptoms
rather than systemic ones. Angina pectoris doesn’t cause weight gain,
nausea, or a decrease in urine output.
37.A. Atherosclerosis. Atherosclerosis accounts for 75% of all abdominal
aortic aneurysms. Plaques build up on the wall of the vessel and
weaken it, causing an aneurysm. Although the other conditions are
related to the development of an aneurysm, none is a direct cause.
38.B. Distal to the renal arteries. The portion of the aorta distal to the
renal arteries is more prone to an aneurysm because the vessel isn’t
surrounded by stable structures, unlike the proximal portion of the
aorta. Distal to the iliac arteries, the vessel is again surrounded by
stable vasculature, making this an uncommon site for an aneurysm.
There is no area adjacent to the aortic arch, which bends into the
thoracic (descending) aorta.
39.A. Abdominal aortic aneurysm. The presence of a pulsating mass in the
abdomen is an abnormal finding, usually indicating an outpouching in
a weakened vessel, as in abdominal aortic aneurysm. The finding,
however, can be normal on a thin person. Neither an enlarged spleen,
gastritis, nor gastic distention cause pulsation.
40.A. Abdominal pain. Abdominal pain in a client with an abdominal aortic
aneurysm results from the disruption of normal circulation in the
abdominal region. Lower back pain, not upper, is a common symptom,
usually signifying expansion and impending rupture of the aneurysm.
Headache and diaphoresis aren’t associated with abdominal aortic
aneurysm.
41.D. Lower back pain. Lower back pain results from expansion of the
aneurysm. The expansion applies pressure in the abdominal cavity,
and the pain is referred to the lower back. Abdominal pain is most
common symptom resulting from impaired circulation. Absent pedal
 pulses are a sign of no circulation and would occur after a ruptured
aneurysm or in peripheral vascular disease. Angina is associated with
atherosclerosis of the coronary arteries.
42.B. Arteriogram. An arteriogram accurately and directly depicts the
vasculature; therefore, it clearly delineates the vessels and any
abnormalities. An abdominal aneurysm would only be visible on an X-
ray if it were calcified. CT scan and ultrasound don’t give a direct view
of the vessels and don’t yield as accurate a diagnosis as the
arteriogram.
43.B. Aneurysm rupture. Rupture of the aneurysm is a life-threatening
emergency and is of the greatest concern for the nurse caring for this
type of client. Hypertension should be avoided and controlled because
it can cause the weakened vessel to rupture. Diminished pedal pulses,
a sign of poor circulation to the lower extremities, are associated with
an aneurysm but isn’t life threatening. Cardiac arrhythmias aren’t
directly linked to an aneurysm.
44.C. Media. The factor common to all types of aneurysms is a damaged
media. The media has more smooth muscle and less elastic fibers, so
it’s more capable of vasoconstriction and vasodilation. The interna and
externa are generally no damaged in an aneurysm.
45.C. Middle lower abdomen to the left of the midline. The aorta lies
directly left of the umbilicus; therefore, any other region is
inappropriate for palpation.
46.B. HPN. Continuous pressure on the vessel walls from hypertension
causes the walls to weaken and an aneurysm to occur. Atherosclerotic
changes can occur with peripheral vascular diseases and are linked to
aneurysms, but the link isn’t as strong as it is with hypertension. Only
1% of clients with syphilis experience an aneurysm. Diabetes mellitus
doesn’t have direct link to aneurysm.
47.A. Bruit. A bruit, a vascular sound resembling heart murmur, suggests
partial arterial occlusion. Crackles are indicative of fluid in the lungs.
Dullness is heard over solid organs, such as the liver. Friction rubs
indicate inflammation of the peritoneal surface.
48.B. Severe lower back pain, decreased BP, decreased RBC, increased
WBC. Severe lower back pain indicates an aneurysm rupture,
secondary to pressure being applied within the abdominal cavity.
When rupture occurs, the pain is constant because it can’t be alleviated
until the aneurysm is repaired. Blood pressure decreases due to the
loss of blood. After the aneurysm ruptures, the vasculature is
interrupted and blood volume is lost, so blood pressure wouldn’t
 increase. For the same reason, the RBC count is decreased – not
increase. The WBC count increases as cells migrate to the site of injury.
49.C. Retroperitoneal rupture at the repair site. Blood collects in the
retroperitoneal space and is exhibited as a hematoma in the perineal
area. This rupture is most commonly caused by leakage at the repair
site. A hernia doesn’t cause vascular disturbances, nor does a pressure
ulcer. Because no bleeding occurs with rapid expansion of the
aneurysm, a hematoma won’t form.
50.C. Marfan’s syndrome. Marfan’s syndrome results in the degeneration
of the elastic fibers of the aortic media. Therefore, clients with the
syndrome are more likely to develop an aortic aneurysm. Although
cystic fibrosis is hereditary, it hasn’t been linked to aneurysms. Lupus
erythematosus isn’t hereditary. Myocardial infarction is neither
hereditary nor a disease.
51.D. Surgical intervention. When the vessel ruptures, surgery is the only
intervention that can repair it. Administration of antihypertensive
medications and beta-adrenergic blockers can help control
hypertension, reducing the risk of rupture. An aortogram is a
diagnostic tool used to detect an aneurysm.
52.A. Cardiomyopathy. Cardiomyopathy isn’t usually related to an
underlying heart disease such as atherosclerosis. The etiology in most
cases is unknown. Coronary artery disease and myocardial infarction
are directly related to atherosclerosis. Pericardial effusion is the
escape of fluid into the pericardial sac, a condition associated with
pericarditis and advanced heart failure.
53.A. Dilated. Although the cause isn’t entirely known, cardiac dilation
and heart failure may develop during the last month of pregnancy of
the first few months after birth. The condition may result from a
preexisting cardiomyopathy not apparent prior to pregnancy.
Hypertrophic cardiomyopathy is an abnormal symmetry of the
ventricles that has an unknown etiology but a strong familial tendency.
Myocarditis isn’t specifically associated with childbirth. Restrictive
cardiomyopathy indicates constrictive pericarditis; the underlying
cause is usually myocardial.
54.C. Hypertrophic. In hypertrophic cardiomyopathy, hypertrophy of the
ventricular septum – not the ventricle chambers – is apparent. This
abnormality isn’t seen in other types of cardiomyopathy.
55.A. Heart failure. Because the structure and function of the heart muscle
is affected, heart failure most commonly occurs in clients with
cardiomyopathy. Myocardial infarction results from prolonged
 myocardial ischemia due to reduced blood flow through one of the
coronary arteries. Pericardial effusion is most predominant in clients
with percarditis. Diabetes mellitus is unrelated to cardiomyopathy.
56.A. Cardiomegaly. Cardiomegaly denotes an enlarged heart muscle.
Cardiomyopathy is a heart muscle disease of unknown origin.
Myocarditis refers to inflammation of heart muscle. Pericarditis is an
inflammation of the pericardium, the sac surrounding the heart.
57.D. Restricitive. These are the classic symptoms of heart failure.
Pericarditis is exhibited by a feeling of fullness in the chest and
auscultation of a pericardial friction rub. Hypertension is usually
exhibited by headaches, visual disturbances and a flushed face.
Myocardial infarction causes heart failure but isn’t related to these
symptoms.
58.B. Hypertrophic. Cardiac output isn’t affected by hypertrophic
cardiomyopathy because the size of the ventricle remains relatively
unchanged. Dilated cardiomyopathy, and restrictive cardomyopathy all
decrease cardiac output.
59.D. Failure of the ventricle to eject all the blood during systole. An S4
occurs as a result of increased resistance to ventricular filling adterl
atrial contraction. This increased resistance is related to decrease
compliance of the ventricle. A dilated aorta doesn’t cause an extra
heart sound, though it does cause a murmur. Decreased myocardial
contractility is heard as a third heart sound. An s4 isn’t heard in a
normally functioning heart.
60.B. Beta-adrenergic blockers. By decreasing the heart rate and
contractility, beta-adrenergic blockers improve myocardial filling and
cardiac output, which are primary goals in the treatment of
cardiomyopathy. Antihypertensives aren’t usually indicated because
they would decrease cardiac output in clients who are often already
hypotensive. Calcium channel blockers are sometimes used for the
same reasons as beta-adrenergic blockers; however, they aren’t as
effective as beta-adrenergic blockers and cause increase hypotension.
Nitrates aren’t’ used because of their dilating effects, which would
further compromise the myocardium.