NSG 6420 MIDTERM EXAM WEEK 4
1. Which of the following is the most important question to ask during cardiovascular
health history?
Student Answer:
Number of offspring
Last physical exam
Sudden death of a family member
Use of caffeine
Instructor Explanation:
The sudden death of a family member is an important question to ask in the health history
because it reveals the cardiovascular disease risk of the patient. Sudden death is usually due to
an acute cardiovascular event, such as myocardial infarction, cardiac dysrhythmia, or stroke.
Family history is particularly important for cardiac assessment because CVD, HTN,
hyperlipidemia, & other vascular diseases often have a familial association that is not easily
ameliorated by lifestyle changes. If there are deaths in the family related to CVD, determine
the age & exact cause of death, because CVD at a young age in the immediate family carries an
increased risk compared with CVD in an elderly family member. Ask about sudden death,
which might indicate a congenital disease such as Marfan's syndrome. This is especially
important to ask during pre-sports physicals because sudden death in athletes is often related
to congenital or familial heart disease. Familial hyperlipidemia is autosomal dominant & often
leads to CAD & MI at a young age.
Family history of obesity & type 2 diabetes are also secondary risk factors for heart disease
because the familial tendency for these is strong. Ask about smoking in the house, as
secondhand smoke is a risk factor for respiratory & cardiac disease. (Goolsby 167-168)
Question 2.
A key symptom of ischemic heart disease is chest pain. However, angina equivalents may
include exertional dyspnea. Angina equivalents are important because:
Student Answer:
a) Women with ischemic heart disease many times do not present with chest pain
b) Some patients may have no symptoms or atypical symptoms;
, c) Diagnosis may only be made at the time of an actual myocardial infarction
d) Elderly patients have the most severe symptoms
A & B only
Instructor Explanation:
The key symptom of IHD is chest pain, but other common symptoms include arm pain, lower
jaw pain, shortness of breath, & diaphoresis. These symptoms are referred to as angina
equivalents & can also include fatigue or breathlessness. Some patients may have no
symptoms or atypical ones so that CAD may not be diagnosed until they experience a
myocardial infarction. (Kennedy-Malone 227)
Question 3. :
A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain
on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus
rhythm without ST segment abnormalities. Your plan may include:
Student Answer:
Echocardiogram
Exercise stress test
Cardiac catheterization
Myocardial perfusion imaging
Instructor Explanation:
Once all the results of the initial laboratory & ECG testing are reviewed, a pretest probability
of disease can be generated & additional tests can be ordered.2 The probability of CAD can be
calculated by considering the chosen noninvasive test's sensitivity & specificity.2 Selection of
the proper cardiac test (see Table 115-1) for an individual depends on the person's risk
stratification, age, & tolerable level of activity. The most common & least invasive test for
diagnosis of CAD is the stress test, also called the exercise tolerance test (ETT) or treadmill
exercise. (Buttaro 488)
Question 4.
Jenny is a 24 year old graduate student that presents to the clinic today with
Student Answer:
Mitral Valve Prolapse
1. Which of the following is the most important question to ask during cardiovascular
health history?
Student Answer:
Number of offspring
Last physical exam
Sudden death of a family member
Use of caffeine
Instructor Explanation:
The sudden death of a family member is an important question to ask in the health history
because it reveals the cardiovascular disease risk of the patient. Sudden death is usually due to
an acute cardiovascular event, such as myocardial infarction, cardiac dysrhythmia, or stroke.
Family history is particularly important for cardiac assessment because CVD, HTN,
hyperlipidemia, & other vascular diseases often have a familial association that is not easily
ameliorated by lifestyle changes. If there are deaths in the family related to CVD, determine
the age & exact cause of death, because CVD at a young age in the immediate family carries an
increased risk compared with CVD in an elderly family member. Ask about sudden death,
which might indicate a congenital disease such as Marfan's syndrome. This is especially
important to ask during pre-sports physicals because sudden death in athletes is often related
to congenital or familial heart disease. Familial hyperlipidemia is autosomal dominant & often
leads to CAD & MI at a young age.
Family history of obesity & type 2 diabetes are also secondary risk factors for heart disease
because the familial tendency for these is strong. Ask about smoking in the house, as
secondhand smoke is a risk factor for respiratory & cardiac disease. (Goolsby 167-168)
Question 2.
A key symptom of ischemic heart disease is chest pain. However, angina equivalents may
include exertional dyspnea. Angina equivalents are important because:
Student Answer:
a) Women with ischemic heart disease many times do not present with chest pain
b) Some patients may have no symptoms or atypical symptoms;
, c) Diagnosis may only be made at the time of an actual myocardial infarction
d) Elderly patients have the most severe symptoms
A & B only
Instructor Explanation:
The key symptom of IHD is chest pain, but other common symptoms include arm pain, lower
jaw pain, shortness of breath, & diaphoresis. These symptoms are referred to as angina
equivalents & can also include fatigue or breathlessness. Some patients may have no
symptoms or atypical ones so that CAD may not be diagnosed until they experience a
myocardial infarction. (Kennedy-Malone 227)
Question 3. :
A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain
on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus
rhythm without ST segment abnormalities. Your plan may include:
Student Answer:
Echocardiogram
Exercise stress test
Cardiac catheterization
Myocardial perfusion imaging
Instructor Explanation:
Once all the results of the initial laboratory & ECG testing are reviewed, a pretest probability
of disease can be generated & additional tests can be ordered.2 The probability of CAD can be
calculated by considering the chosen noninvasive test's sensitivity & specificity.2 Selection of
the proper cardiac test (see Table 115-1) for an individual depends on the person's risk
stratification, age, & tolerable level of activity. The most common & least invasive test for
diagnosis of CAD is the stress test, also called the exercise tolerance test (ETT) or treadmill
exercise. (Buttaro 488)
Question 4.
Jenny is a 24 year old graduate student that presents to the clinic today with
Student Answer:
Mitral Valve Prolapse
