MEDICAL SURGICAL NURSING 2020

CARDIOVASCULAR DRILLS (OFFLINE)

ALL THE ANSWERS ARE LETTER A, since the online exam is shuffled. Rationale is below each option.

1. Which term is used to describe the ability of the heart to initiate an electrical impulse?
a) Automaticity
Automaticity is the ability of specialized electrical cells of the cardiac conduction system to initiate an
electrical impulse.
b) Contractility
Contractility refers to the ability of the specialized electrical cells of the cardiac conduction system to
contract in response to an electrical impulse.
c) Conductivity
Conductivity refers to the ability of the specialized electrical cells of the cardiac conduction system to
transmit an electrical impulse from one cell to another.
d) Excitability
Excitability refers to the ability of the specialized electrical cells of the cardiac conduction system to
respond to an electrical impulse.

2. The nurse auscultates the apex beat at which of the following anatomical locations?
a) Fifth intercostal space, midclavicular line
The left ventricle is responsible for the apex beat or the point of maximum impulse, which is normally
palpable in the left midclavicular line of the chest wall at the fifth intercostal space.
b) Mid-sternum
The right ventricle lies anteriorly, just beneath the sternum.
c) 2‖ to the left of the lower end of the sternum
Use of inches to identify the location of the apex beat is inappropriate based upon variations in human
anatomy.
d) 1‖ to the left of the xiphoid process
Auscultation below and to the left of the xiphoid process will detect gastrointestinal sounds, but not the
apex beat of the heart.

3. Which of the following terms describes the amount of blood ejected per heartbeat?
a) Stroke volume
Stroke volume is determined by preload, afterload, and contractility.
b) Cardiac output
Cardiac output is the amount of blood pumped by each ventricle during a given period and is computed
by multiplying the stroke volume of the heart by the heart rate.
c) Ejection fraction
Ejection Fraction is the percentage of the end-diastolic volume that is ejected with each stroke,
measured at 42–50% in the normal heart.
d) Afterload
Afterload is defined as the pressure that the ventricular myocardium must overcome to eject blood during
systole and is one of the determinants of stroke volume.

4. When measuring the blood pressure in each of the patient’s arms, the nurse recognizes that in the
normal adult, the pressures:
a) differ no more than 5 mm Hg between arm pressures.
Normally, in the absence of disease of the vasculature, there is a difference of no more than 5 mm Hg
between arm pressures.
b) must be equal in both arms.
The pressures in each arm do not have to be equal in order to be considered normal.
c) may vary 10 mm Hg or more between arms.
Pressures that vary more than 10 mm Hg between arms indicate an abnormal finding.
d) may vary, with the higher pressure found in the left arm.
The left arm pressure is not anticipated to be higher than the right as a normal anatomical variant.
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5. Central venous pressure is measured in which of the following heart chambers?
a) Right atrium
The pressure in the right atrium is used to assess right ventricular function and venous blood return to the
heart.
b) Left atrium
The left atrium receives oxygenated blood from the pulmonary circulation.
c) Left ventricle
The left ventricle receives oxygenated blood from the left atrium.
d) Right ventricle
The right ventricle is not the central collecting chamber of venous circulation.

6. Which of the following ECG characteristics is usually seen when a patient’s serum potassium level is
low?
a) U wave
The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually
seen when a patient’s serum potassium level is low.
b) T wave
The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or
―peaked‖ if a patient’s serum potassium level is high.
c) P wave
The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria.
d) QT interval
The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to
repolarization.

7. Which of the following ECG waveforms characterizes conduction of an electrical impulse through the
left ventricle?
a) QRS complex
The QRS complex represents ventricular depolarization
b) P wave
The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria.
c) PR interval
The PR interval is a component of an ECG tracing reflecting conduction of an electrical impulse through
the AV node.
d) QT interval
The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to
repolarization.

8. When the nurse observes that the patient’s heart rate increases during inspiration and decreases
during expiration, the nurse reports that the patient is demonstrating
a) sinus dysrhythmia.
Sinus dysrhythmia occurs when the sinus node creates an impulse at an irregular rhythm.
b) normal sinus rhythm.
Normal sinus rhythm occurs when the electrical impulse starts at a regular rate and rhythm in the SA
node and travels through the normal conduction pathway.
c) sinus bradycardia.
Sinus bradycardia occurs when the sinus node regularly creates an impulse at a slower-than-normal rate.
d) sinus tachycardia.
Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate.

9. Which of the following terms is used to describe a tachycardia characterized by abrupt onset, abrupt
cessation, and a QRS of normal duration?
a) Paroxysmal atrial tachycardia
PAT is often caused by a conduction problem in the AV node and is now called AV nodal re-entry
tachycardia.
b) Sinus tachycardia
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Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate.
c) Atrial flutter
Atrial flutter occurs in the atrium and creates an atrial rate between 250-400 times per minute.
d) Atrial fibrillation
Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature.

10. When the nurse observes an ECG tracing on a cardiac monitor with a pattern in lead II and observes
a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following
ventricular dysrhythmias?
Premature ventricular contraction
A PVC is an impulse that starts in a ventricle before the next normal sinus impulse.
a) Ventricular bigeminy
Ventricular bigeminy is a rhythm in which every other complex is a PVC.
b) Ventricular tachycardia
Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100
beats per minute.
c) Ventricular fibrillation
Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the
ventricles.

11. Premature ventricular contractions are considered precursors of ventricular tachycardia when they:
a) occur at a rate of more than six per minute.
When PVCs occur at a rate of more than six per minute they indicate increasing ventricular irritability and
are considered forerunners of ventricular tachycardia (VT).
b) occur during the QRS complex.
PVCs are dangerous when they occur on the T wave.
c) have the same shape.
PVCs are dangerous when they are multifocal (have different shapes).
d) are paired with a normal beat.
A PVC that is paired with a normal beat is termed bigeminy.

12. When no atrial impulse is conducted through the AV node into the ventricles, the patient is said to be
experiencing which type of AV block?
a) Third degree
In third degree heart block, two impulses stimulate the heart—one stimulates the ventricles and one
stimulates the atria.
b) First degree
In first degree heart block, all the atrial impulses are conducted through the AV node into the ventricles at
a rate slower than normal.
c) Second degree, type I
In second degree AV block, type I, all but one of the atrial impulses are conducted through the AV node
into the ventricles.
d) Second degree, type II
In second degree AV block, type II, only some of the atrial impulses are conducted through the AV node
into the ventricles.

13. Which of the following terms refers to chest pain brought on by physical or emotional stress and
relieved by rest or medication?
a) angina pectoris
Angina pectoris is a symptom of myocardial ischemia.
b) atherosclerosis
Atherosclerosis is an abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and
lumens.
c) atheroma
Atheromas are fibrous caps composed of smooth muscle cells that form over lipid deposits within arterial
vessels.
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d) ischemia
Ischemia is insufficient tissue oxygenation and may occur in any part of the body.

14. Of the following risk factors, which is considered modifiable?

a) Diabetes mellitus
While diabetes mellitus cannot be cured, blood sugars and symptomatology can be managed through
healthy heart living.
b) Gender
Gender is considered a non-modifiable risk factor.
c) Race
Race is considered a non-modifiable risk factor.
d) Increasing age
Increasing age is considered a non-modifiable risk factor.

15. When the patient with known angina pectoris complains that he is experiencing chest pain more
frequently even at rest, the period of pain is longer, and it takes less stress for the pain to occur, the nurse
recognizes that the patient is describing
a) unstable angina.
Unstable angina is also called crescendo or pre-infarction angina and indicates the need for a change in
treatment.
b) intractable angina.
Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to
conventional treatment.
c) variant angina.
Variant angina is described as pain at rest with reversible ST-segment elevation and is thought to be
caused by coronary artery vasospasm.
d) refractory angina.
Intractable or refractory angina produces severe, incapacitating chest pain that does not respond to
conventional treatment.

16. Heparin therapy is usually considered therapeutic when the patient’s activated partial thromboplasin
time (aPTT) is how many times normal?
a) 1.5 to 2
The amount of heparin administered is based on aPTT results, which should be obtained in follow-up to
any alteration of dosage.
b) .5 to 1
The patient’s aPTT value would have to be greater than .5 to 1 times normal to be considered
therapeutic.
c) 2.5 to 3
An aPTT value that is 2.5 to 3 times normal would be too high to be considered therapeutic.
d) .25 to .75
The patient’s aPTT value would have to be greater than .25 to .75 times normal to be considered
therapeutic.

17. When the post-cardiac surgery patient demonstrates restlessness, nausea, weakness, and peaked T
waves, the nurse reviews the patient’s serum electrolytes anticipating which abnormality?
a) Hyperkalemia
Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall,
peaked T waves).
b) Hypercalcemia
Hypercalcemia would likely be demonstrated by asystole.
c) Hypomagnesemia
Hypomagenesemia would likely be demonstrated by hypotension, lethargy, and vasodilation.
d) Hyponatremia
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Hyponatremia would likely be indicated by weakness, fatigue, and confusion without change in T wave
formation.

18. In order to be effective, Percutaneous Transluminal Coronary Angioplasty (PTCA) must be performed
within what time frame, beginning with arrival at the emergency department after diagnosis of myocardial
infarction?
a) 60 minutes
The sixty minute interval is known as ―door to balloon time‖ for performance of PTCA on a diagnosed MI
patient.
b) 30 minutes
The thirty minute interval is known as ―door to needle‖ time for administration of thrombolytics post MI.
c) 9 days
The time frame of nine (9) days refers to the time for onset of vasculitis after administration of
Streptokinase for thrombolysis in an acute MI patient.
d) 6-12 months
The six to twelve month time frame refers to the time period during which streptokinase will not be used
again in the same patient for acute MI.

19. Which of the following statements reflect a goal of rehabilitation for the patient with an MI:
a) To improve the quality of life
Overall, cardiac rehabilitation is a complete program dedicated to extending and improving quality of life.
b) To limit the effects and progression of atherosclerosis
An immediate objective of rehabilitation of the MI patient is to limit the effects and progression of
atherosclerosis.
c) To return the patient to work and a pre illness lifestyle
An immediate objective of rehabilitation of the MI patient is to return the patient to work and a pre illness
lifestyle.
d) To prevent another cardiac event
An immediate objective of rehabilitation of the MI patient is to prevent another cardiac event.

20. Which of the following methods to induce hemostasis after sheath removal post Percutaneous
Transluminal Coronary Angioplasty is the least effective?
a) Application of a sandbag to the area
Several nursing interventions frequently used as part of the standard of care, such as applying a sandbag
to the sheath insertion site, have not been shown to be effective in reducing the incidence of bleeding.
b) Application of a vascular closure device, such as AngiosealTM, VasosealTM, DuettTM, Syvek
patchTM
Application of a vascular closure device has been demonstrated to be very effective.
c) Direct manual pressure
Direct manual pressure to the sheath introduction site has been demonstrated to be effective and was the
first method used to induce hemostasis post PTCA.
d) Application of a pneumatic compression device (e.g., Fem-StopTM)
Application of a pneumatic compression device post PTCA has been demonstrated to be effective.

21. A long-term effect of which of the following procedures post acute MI induces angioneogenesis?
a) Transmyocardial laser revascularization
TNR procedures usually involves making 20 to 40 channels in ventricular muscle. It is thought that some
blood flows into the channels, decreasing the ischemia directly. Within the next few days to months, the
channels close as a result of the body’s inflammatory process of healing a wound and new blood vessels
form as a result of the inflammatory process.
b) Bracytherapy
Brachytherapy involves the delivery of gamma or beta radiation by placing a radioisotope close to the
lesion and has been shown to be effective in reducing the recurrence of obstruction, preventing vessell
restenosis by inhibiting smooth muscle cell proliferation.
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c) Atherectomy
Atherectomy is an invasive interventional procedure that involves the removal of the atheroma, or plaque,
from a coronary artery.
d) Stent placement
A stent is a woven stainless steel mesh that provides structural support to a vessel at risk of acute
closure. Eventually, endothelium covers the stent and it is incorporated into the vessel wall. Because of
the risk of thrombus formation in the stent, the patient receives antiplatelet medications (e.g., clopidigrel
[Plavix]) therapy for 2 weeks and lifetime use of aspirin).

22. Which of the following medications are used to reverse the effects of heparin?
a) Protamine sulphate
Protamine sulfate is known as the antagonist to heparin.
b) Streptokinase
Streptokinase is a thrombolytic agent.
c) Clopidigrel (Plavix)
Clopidigrel (Plavix) is an antiplatelet medication that is given to reduce the risk of thrombus formation post
coronary stent placement.
d) Aspirin
The antiplatelet effect of aspirin does not reverse the effects of heparin.

23. Which of the following terms refers to leg pain that is brought on walking and caused by arterial
insufficiency?
a) Intermittent claudication
Intermittent claudication is leg pain that is brought on by exercise and relieved by rest.
b) Dyspnea
Dyspnea is the patient’s subjective statement of difficulty breathing.
c) Orthopnea
Orthopnea is the inability of the patient to breathe except in the upright (sitting) position.
d) Thromboangitis obliterans
Thomroangitis obliterans is a peripheral vascular disease also known as Burger’s disease.

24. When the post-cardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow
gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse
suspects which of the following electrolyte imbalances?
a) Hypermagnesemia
Untreated hypomagnesemia may result in coma, apnea, cardiac arrest.
b) Hypokalemia
Signs and symptoms of hypokalemia include signs of digitalis toxicity and dysrhythmias (U wave, AV
block, flat or inverted T waves).
c) Hyperkalemia
Signs of hyperkalemia include: mental confusion, restlessness, nausea, weakness, paresthesias of
extremities, dysrhythmias (tall, peaked T waves; increased amplitude, widening QRS complex; prolonged
QT interval).
d) Hypomagnesemia
Signs and symptoms of hypomagnesemia include: paresthesias, carpopedal spasm, muscle cramps,
tetany, irritability, tremors, hyperexcitability, hyperreflexia, cardiac dysrhythmias (prolonged PR and QT
intervals, broad flat T waves), disorientation, depression, and hypotension.

25. When the nurse notes that the post cardiac surgery patient demonstrates low urine output (< 25 ml/hr)
with high specific gravity (> 1.025), the nurse suspects:
a) Inadequate fluid volume
Urine output of less than 25 ml/hr may indicate a decrease in cardiac output. A high specific gravity
indicates increased concentration of solutes in the urine which occurs with inadequate fluid volume.
b) Normal glomerular filtration
Indices of normal glomerular filtration are output of 25 ml or greater per hour and specific gravity between
1.010 and 1.025.
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c) Overhydration
Overhydration is manifested by high urine output with low specific gravity.
d) Anuria
The anuric patient does not produce urine.

26. When the valve used in valve replacement surgery is made from the patient’s own heart valve, which
of the following terms is used?
a) Autograft
An example of autograft is found when the surgeon excises the pulmonic valve and uses it for an aortic
valve replacement.
b) Allograft
Allograft refers to replacement using human tissue and is a synonym for homograft.
c) Homograft
Homograft refers to replacement using human tissue and is a synonym for allograft.
d) Xenograft
Xenograft refers to replacement of tissue from animal tissue.

27. Which of the following procedures most specifically describes splitting or separating fused cardiac
valve leaflets?
a) Commisurotomy
Commisurotomy is frequently used for mitral stenosis.
b) Annuloplasty
Annuloplasty refers to repair of a cardiac valve’s outer ring.
c) Chordoplasty
Chordoplasty refers to repair of the chordae tendonae of atroventricular valve leaflets.
d) Valvuloplasty
Valvuloplasty is a general term that refers to repair of a stenosed or regurgitant cardiac valve by
commisurotomy, annuloplasty, leaflet repair, and/or chordoplasty.

28. Which of the following mitral valve conditions generally produces no symptoms?
a) Prolapse
Mitral valve prolapse is a deformity that usually produces no symptoms and has been diagnosed more
frequently in recent years, probably as a result of improved diagnostic methods.
b) Stenosis
Mitral valve stenosis usually causes progressive fatigue.
c) Regurgitation
Mitral valve regurgitation, in its acute stage, usually presents as severe heart failure.
d) Infection
Mitral valve infection, when acute, will produce symptoms typical of infective endocarditis.

29. In which type of cardiomyopathy does the heart muscle actually increase in size and mass weight,
especially along the septum?
a) Hypertrophic
Because of the structural changes, hypertrophic cardiomyopathy had also been called idiopathic
hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH).
b) Dilated
Because of the structural changes, hypertrophic cardiomyopathy had also been called idiopathic
hypertrophic subaortic stenosis (IHSS) or asymmetric septal hypertrophy (ASH).
c) Restrictive
Restrictive cardiomyopathy is characterized by diastolic dysfunction caused by rigid ventricular walls that
impair ventricular stretch and diastolic filling
d) Arrhythmogenic right ventricular cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy (ARVC) occurs when the myocardium of the right
ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue
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30. Which of the following patient behaviors, if observed by the nurse, would indicate that the cardiac
patient’s level of anxiety has decreased?
a) Answers questions regarding status with no problem.
Generally, when anxiety begins to increase, the patient will be less likely to want to discuss prognosis.
b) Discusses prognosis freely.
Open discussion generally indicates some degree of comfort with prognosis.
c) Verbalizes fears and concerns.
Verbalization of fears and concerns indicates some degree of comfort with prognosis.
d) Participates in support groups.
Participation in support groups indicates some degree of comfort with prognosis.

31. The patient with which of the follow characteristics is considered high risk for the development of
infective endocarditis?
a) The patient who has complex cyanotic congenital malformations is at high risk for the development
of infective endocarditis.
b) Mitral valve prolapse with valvular regurgitation
The patient with mitral valve prolapse with valvular regurgitation is at moderate risk for the development
of infective endocarditis.
c) Hypertrophic cardiomyopathy
The patient with hypertrophic cardiomyopathy is at moderate risk for the development of infective
endocarditis.
d) Acquired valvular dysfunction
The patient with acquired valvular dysfunction is at moderate risk for the development of infective
endocarditis.

32. Which of the following terms indicates the amount of blood pumped out of the ventricle with each
contraction of the heart?
a) Stroke volume
Stroke volume is the amount of blood pumped out (ejected) with each contraction of the heart (heart
beat). Stroke volume times heart rate equals cardiac output.
b) Afterload
Afterload is the amount of resistance to ejection of blood from a ventricle.
c) Cardiac output
Cardiac output is the amount of blood pumped out of the heart in one minute.
d) Preload
Preload is the pressure created by a volume of blood within a ventricle before contraction.

33. When the balloon on the distal tip of a pulmonary artery catheter is inflated and a pressure is
measured, the measurement obtained is referred to as the:
a) pulmonary artery wedge pressure.
When the balloon is inflated, the tip of the catheter floats into smaller branches of the pulmonary arty until
it can no longer be passed and the pressure is recorded, reflecting left atrial pressure and left ventricular
end-diastolic pressure.
b) central venous pressure.
Central venous pressure is measured in the right atrium.
c) pulmonary artery pressure.
Pulmonary artery pressure is measured when the balloon tip is not inflated.
d) cardiac output.
Cardiac output is determined through thermodilution involving injection of fluid into the pulmonary artery
catheter.

34. Which of the following medications is categorized as a loop diuretic?

a) Furosemide (Lasix)
Lasix is commonly used in the treatment of cardiac failure.
b) Chlorothiazide (Diuril)
Chlorothiazide is categorized as a thiazide diuretic.
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c) Chlorthalidone (Hygroton)
Chlorothalidone is categorized as a thiazide diuretic.
d) Spironolactone (Aldactone)
Spironolactone is categorized as a potassium-sparing diuretic.

35. When the nurse observes that the patient always has difficulty breathing when lying flat, the nurse
records that the patient is demonstrating
a) Orthopnea
Patients with orthopnea prefer not to lie flat and will need to maintain their beds in a semi- to high
Fowler’s position
b) Dyspnea on exertion.
Dyspnea on exertion refers to difficulty breathing with activity.
c) Hyperpnea.
Hyperpnea refers to increased rate and depth of respiration.
d) Paroxysmal nocturnal dyspnea.
Paroxysmal nocturnal dyspnea refers to orthopnea that occurs only at night.

36. The patient with cardiac failure is taught to report which of the following symptoms to the physician or
clinic immediately?
a) Persistent cough
Persistent cough may indicate an onset of left-heart failure.
b) Increased appetite
Loss of appetite should be reported immediately.
c) Weight loss
Weight gain should be reported immediately.
d) Ability to sleep through the night
Frequent urination, causing interruption of sleep, should be reported immediately.

37. A classic sign of cardiogenic shock is

a) Tissue hypoperfusion
Tissue hypoperfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation).
b) High blood pressure
Low blood pressure is a classic sign of cardiogenic shock.
c) Hyperactive bowel sounds
Hypoactive bowel sounds are classic signs of cardiogenic shock.
d) Increased urinary output
Decreased urinary output is a classic sign of cardiogenic shock.

38. Vasoactive drugs which cause the arteries and veins to dilate, thereby shunting much of the
intravascular volume to the periphery and causing a reduction in preload and afterload include agents
such as
a) Sodium nitroprusside (Nipride)
Sodium nitroprusside is used in the treatment of cardiogenic shock.
b) Norepinephrine (Levophed)
Norepinephrine (Levophed) is a vasopressor that is used to promote perfusion to the heart and brain.
c) Dopamine (Inotropin)
Dopamine (Inotropin) tends to increase the workload of the heart by increasing oxygen demand; thus, it is
not administered early in the treatment of cardiogenic shock.
d) Furosemide (Lasix)
Furosemide (Lasix) is a loop diuretic that reduces intravascular fluid volume.

39. Which of the following terms refers to a muscular, cramp-like pain in the extremities consistently
reproduced with the same degree of exercise and relieved by rest?
a) Intermittent claudication
Intermittent claudication is a sign of peripheral arterial insufficiency.
b) Aneurysm
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An aneurysm is a localized sac of an artery wall formed at a weak point in the vessel.
c) Bruit
A bruit is the sound produced by turbulent blood flow through an irregular, tortuous, stenotic, or dilated
vessel.
d) Ischemia
Ischemia is a term used to denote deficient blood supply.

40. Which of the following observations regarding ulcer formation on the patient’s lower extremity indicate
to the nurse that the ulcer is a result of venous insufficiency?
a) The border of the ulcer is irregular.
The border of an ulcer caused by arterial insufficiency is circular.
b) The ulcer is very painful to the patient, even though superficial.
Superficial venous insufficiency ulcers cause minimal pain.
c) The ulcer base is pale to black.
The base of a venous insufficiency ulcer shows beefy red to yellow fibrinous color.
d) The ulcer is deep, involving the joint space.
Venous insufficiency ulcers are usually superficial.

41. A diagnostic test that involves injection of a contrast media into the venous system through a dorsal
vein in the foot is termed:
a) contrast phlebography.
When a thrombus exists, an x-ray image will disclose an unfilled segment of a vein.
b) air plethysmography
Air plethysmography quantifies venous reflux and calf muscle pump ejection.
c) lymphangiography.
In lymphangiography, contrast media are injected into the lymph system.
d) lymphoscintigraphy.
In lymphoscintigraphy, a radioactive-labeled colloid is injected into the lymph system.

42. The nurse teaches the patient with peripheral vascular disease to refrain from smoking because
nicotine causes
a) vasospasm.
Nicotine causes vasospasm and can thereby dramatically reduce circulation to the extremities.
b) slowed heart rate.
Nicotine has stimulant effects.
c) depression of the cough reflex.
Nicotine does not suppress cough. Smoking irritates the bronchial tree, causing coughing.
d) diuresis.
Nicotine does not cause diuresis.

43. Which of the following types of aneurysms results in bleeding into the layers of the arterial wall?
a) Dissecting
Dissection results from a rupture in the intimal layer, resulting in bleeding between the intimal and medial
layers of the arterial wall.
b) Saccular
Saccular aneurysms collect blood in the weakened outpouching.
c) False
In a false aneurysm, the mass is actually a pulsating hematoma.
d) Anastomotic
An anastomotic aneurysm occurs as a result of infection at arterial suture or graft sites.

44. Which of the following terms is given to hypertension in which the blood pressure, which is controlled
with therapy, becomes uncontrolled (abnormally high) with the discontinuation of therapy?
a) Rebound
Rebound hypertension may precipitate a hypertensive crisis.
b) Essential
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Essential or primary hypertension denotes high blood pressure from an unidentified source.
c) Primary
Essential or primary hypertension denotes high blood pressure from an unidentified source.
d) Secondary
Secondary hypertension denotes high blood pressure from an identified cause, such as renal disease.

45. The nurse teaches the patient which of the following guidelines regarding lifestyle modifications for
hypertension?
a) Maintain adequate dietary intake of potassium
In general, one serving of a potassium-rich food such as banana, kale, broccoli, or orange juice will meet
the daily need for potassium.
b) Reduce smoking to no more than four cigarettes per day
The patient should be guided to stop smoking.
c) Limit aerobic physical activity to 15 minutes, three times per week
The general guideline is to advise the patient to increase aerobic activity to 30 to 45 minutes most days of
the week.
d) Stop alcohol intake
In general, alcohol intake should be limited to no more than 1 oz of ethanol per day.

46. Of the following diuretic medications, which conserves potassium?

a) Spironolactone (Aldactone)
Aldactone is known as a potassium-sparing diuretic.
b) Furosemide (Lasix)
Lasix causes loss of potassium from the body.
c) Chlorothiazide (Diuril)
Diuril causes mild hypokalemia.
d) Chlorthalidone (Hygroton)
Hygroton causes mild hypokalemia.

47. Which of the following adrenergic inhibitors acts directly on the blood vessels, producing vasodilation?
a) Prazosin hydrochloride (Minipress)
Minipress is a peripheral vasodilator acting directly on the blood vessel. It is not used in angina and
coronary artery disease, however, because it induces tachycardia if not preceded by administration of
propranolol and a diuretic.
b) Reserpine (Serpasil)
Serpasil impairs synthesis and reuptake of norepinephrine.
c) Propranolol (Inderal)
Inderal blocks the beta-adrenergic receptors of the sympathetic nervous system, especially the
sympathetics to the heart, producing a slower heart reate and lowered blood pressure.
d) Clonidine hydrochloride (Catapres)
Catapres acts through the central nervous system, apparently through centrally mediated alpha-
adrenergic stimulation in the brain, producing blood pressure reduction.

48. Which of the following terms refers to an abnormal decrease in white blood cells, red blood cells, and
platelets?
a) Pancytopenia
Pancytopenia may be congenital or acquired.
b) Anemia
Anemia refers to decreased red cell mass.
c) Leukopenia
Leukopenia refers to a less-than-normal amount of WBCs in circulation.
d) Thrombocytopenia
Thrombocytopenia refers to a lower-than-normal platelet count.

49. Which of the following terms refers to a form of white blood cell involved in immune response?
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a) Lymphocyte
Both B and T lymphocytes respond to exposure to antigens.
b) Granulocyte
Granulocytes include basophils, neutrophils, and eosinophils.
c) Spherocyte
A spherocyte is a red blood cell without central pallor, seen with hemolysis.
d) Thrombocyte
A thombocyte is a platelet.

50. The term that is used to refer to a primitive cell, capable of self-replication and differentiation, is:
a) stem cell.
Stem cells may differentiate into myeloid or lymphoid stem cells.
b) band cell.
A band cell is a slightly immature neutrophil.
c) spherocyte.
A spherocyte is a red blood cell without central pallor.
d) reticulocyte.
A reticulocyte is a slightly immature red blood cell.