Question 24
In a patient with systemic vasodilation from sepsis, blood pressure drops significantly. The advanced practice nurse understands this occurs because:
- Blood viscosity is the main determinant of blood pressure
- Vessel radius has a minimal effect on resistance
- Small increases in vessel radius greatly reduce resistance
- Vessel length determines resistance more than vessel radius
Question 25
An advanced practice provider has a patient in the ICU and observed that the patient is having a large spike in their blood pressure. What would cause an almost immediate rise in blood pressure?
- A drop in oxygen saturation has occurred.
- The normal circadian variation in blood pressure.
- A large drop in carbon dioxide level in arterial blood.
- The patient has recently had their oxygen increased to 100%.
Question 26
A patient who is recovering from surgery in SICU notices swelling, pain and tenderness of his left leg. A deep vein thrombosis (DVT) is suspected. Which conditions increase this patient’s risk of DVT?
- Hypocoagulability, vessel wall injury, increased pressure on deep veins.
- Vessel wall injury, hypocoagulability, decreased venous blood flow.
- Stasis of blood, hypercoagulability, inflammation.
- Stasis of blood, hypercoagulability, vessel wall injury.
Question 27
You auscultate a swishing sound during diastole. Which note in the chart would best describe the time during which you auscultated this diastolic murmur?
- Diastolic murmurs are heard when the ventricles are relaxed and filling with blood.
- Diastolic murmurs are heard during the period when the ventricles are contracting.
- Diastolic murmurs are always auscultated as an S3 heart sound, between the S1 and S2 sounds.
- Diastolic murmurs are heard when both the aortic and pulmonic valves are open.
Question 28
The nurse practitioner identifies which condition as a major complication of long-term build up of plaque in the coronary arteries?
- Motor deficits in muscles proximal to plaque formation
- Necrosis of the vessel wall
- Peripheral vasodilation to compensate for ischemia
- Aneurysm formation due to weakening of blood vessel walls
Question 29
An older patient presents with a new onset of shortness of breath. The nurse practitioner (NP) has ordered natriuretic peptide levels along with other diagnostic tests and lab work. What is the most accurate rationale for the NP’s choice of blood work?
- Natriuretic peptide levels correlate with the client’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia.
- Natriuretic peptides are an indirect indicator of the effectiveness of the renin-angiotensin-aldosterone (RAA) system in compensating for heart failure.
- Natriuretic peptides become elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.
- Natriuretic peptides are released as a compensatory mechanism during heart failure, and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology.
Question 30
A 30-year-old woman, G2P1, at 28 weeks’ gestation presents for a routine prenatal visit. Her blood pressure today is 148/96 mmHg, compared to 110/70 mmHg at 12 weeks. She denies visual changes or headache. Urinalysis shows no proteinuria. Her previous pregnancy was normotensive. The nurse practitioner explains that during a normal pregnancy, there is a slight drop in blood pressure during mid-pregnancy. However, this patient’s findings suggest which hypertensive disorder of pregnancy?
- She has gestational diabetes and will need to be monitored throughout pregnancy.
- She has presented with preeclampsia and must be monitored continuously until delivery.
- She has chronic hypertension and must be prepared for lifelong treatment.
- She has gestational hypertension which will hopefully resolve on its own after delivery.
Question 31
The nurse practitioner is teaching a course on the cardiovascular system. When discussing what happens to the valves during the ejection period of systole, which response is true?
- The AV valves are closed and the semilunar valves are open.
- The ventricles are relaxing and filling with blood.
- Ventricular pressure is rising abruptly.
- The AV valves are open and the semilunar valves are closed.
Question 32
A 42-year-old man presents with sharp, substernal chest pain that worsens when lying flat and improves when sitting forward. A pericardial friction rub is auscultated. ECG shows diffuse ST-segment elevation. Which mechanism best explains his symptoms?
- Thickening of the ventricular wall reducing cardiac output
- Inflammation of the pericardial layers causing friction during cardiac movement
- Constriction of the coronary arteries causing myocardial ischemia
- Valve regurgitation increasing left atrial pressure
Question 33
Chronic elevation of left ventricular end-diastolic pressure will result in which clinical manifestations?
- Dyspnea and crackles in bilateral lung bases.
- Petechia and spontaneous bleeding.
- Venous distention and liver congestion.
- Muscle cramping and cyanosis in the feet.
Question 34
The nurse practitioner reads in the patient’s chart that the patient has “a reduction in coronary artery blood flow that is insufficient to meet the oxygen needs of the heart without necrosis”. The NP summarizes these findings in which of the following entries?
- The patient has a pericardial effusion.
- The patient is experiencing a myocardial infarction.
- This patient is suffering from Raynaud’s phenomenon.
- The patient is experiencing myocardial ischemia.
Question 35
A patient with chronic smoking history develops endothelial dysfunction. The nurse understands that this condition primarily impairs which function of the endothelium?
- Release of digestive enzymes into circulation
- Control of erythropoietin synthesis
- Production of angiotensin II by the adrenal gland
- Regulation of platelet adhesion and vascular tone
Question 36
A patient is in the cardiac clinic due to a dysrhythmia. Errant conduction system cells suspected to be the cause. What is a primary difference between the typical conduction system cells and the cardiac pacemaker cells?
- Pacemaker cells have the ability to depolarize themselves without depending on a neighboring cell.
- Typical conduction system cells are easily influenced by the autonomic nervous system, moving the curved phase 4 up or down.
- Pacemaker cells depend only on the movement of calcium across membranes in order to depolarize.
- Specialized pacemaker cells are much more common and make up the majority of the conduction pathways in the heart.
Question 37
A patient presents to the emergency department with a pulsating mass in their abdomen. How does the nurse practitioner explain the probable diagnosis to the patient?
- “The blood vessel leading to your kidneys is most likely necrotic, causing the bulge you are seeing.”
- “You likely have an abnormal dilation of your abdominal aorta, the largest vessel in your body.”
- “You more than likely have an abnormal outpouching of a vessel in your circle of Willis.”
- “The abnormal mass in your abdomen is due to intense vasospasm of your descending aorta.”
Question 38
The nurse practitioner is reads in the patient’s chart the diagnosis of hypertrophic cardiomyopathy. Which feature distinguishes hypertrophic cardiomyopathy from other types?
- Ventricular dilation during the third trimester and after pregnancy
- Ventricular hypertrophy with impaired filling of the heart
- Fibrosis restricting diastolic relaxation and therefore filling of the heart
- Thin ventricular walls and poor contraction of the heart muscle
Question 39
A patient admitted with sinus tachycardia at a rate of 145 beats per minute. The advanced practice practitioner should include which question in the initial interview with the patient in order to help determine treatment?
- Have any of your immediate family members experienced an increased heart rate?
- How many times a week do you exercise?
- Do you have a history of any gastrointestinal issues?
- Are you currently experiencing any pain?
Question 40
At rest, a patient’s blood pressure is 120/80. The patient suddenly stands up sitting down. His repeat blood pressure is 118/78. Which baroreceptor response explains this maintenance of blood pressure?
- The patient’s parasympathetic output increased causing a decrease in heart rate.
- The patient sympathetic tone is increased causing vasoconstriction and tachycardia.
- Catecholemine release is inhibited in this patient causing decreased heart rate and blood pressure.
- The patient is experiencing decreased sympathetic activity causing vasodilation.
Question 41
A United Parcel Service (UPS) employee comes to the clinic for the removal of varicose veins. The patient reports that her job includes standing for hours at a time to lift and sort packages. The patient asks the nurse practitioner why she has varicose veins at all. Which response is best?
- “Standing increases venous pressure leading to valve incompetence and varicose veins.”
- “Standing decreases cardiac output leading to venous congestion of blood.”
- “Your job stress is causing leg weakness, allowing for these aneurysms to form in your lower legs.”
- “You are experiencing inflammation of the arterial walls causing them to varicose.”
Question 43
The advanced practice provider is teaching the patient about hypercholesterolemia. The 52-year-old male patient started on a statin drug for his elevated LDL and total cholesterol. In the teaching, which factor is discussed as being most likely to contribute to this finding?
- Decreased hepatic LDL receptor activity has most likely led to these findings.
- Increasing age is the biggest risk factor for the development of hyperlipidemia.
- Increased HDL synthesis will indirectly increase LDL levels.
- Increased endothelial nitric oxide production will cause serum lipid levels to rise.
Question 44
A 55-year-old male presents with a blood pressure reading of 160/98 mmHg during his routine check-up. He has a family history of hypertension and is overweight. What is the most likely pathophysiological cause of his elevated blood pressure?
- Inadequate sodium excretion by the kidneys leading to fluid retention
- Decreased vascular tone due to endothelial dysfunction
- Reduced cardiac output due to impaired myocardial contractility
- Increased sympathetic nervous system activity causing vasoconstriction
