Test Bank Chapter 19- Disorders of Cardiac Function

1.The plaques in a client's coronary arteries are plentiful, and most have small- to moderate-sized lipid cores with thick fibrous caps. This form of atherosclerosis is most closely associated with which of the following diagnoses? A) Stable angina B) Non–ST-segment elevation MI C) ST-segment elevation MI D) Unstable angina Ans: A Feedback: The fixed or stable plaque is commonly associated with stable angina, and the unstable plaque is implicated in unstable angina and myocardial infarction (MI). 2.Atherosclerotic plaque is most likely to be unstable and vulnerable to rupture when the plaque has a thin fibrous cap over a: A) Red thrombus B) Large lipid core C) Calcified lesion D) Vessel wall injury Ans: B Feedback: Plaque disruption causes thrombus formation, with white platelet-containing thrombi being associated with unstable angina. The major determinants of plaque vulnerability to disruption include the size of its lipid-rich core, lack of stabilizing smooth muscle cells, presence of inflammation with plaque degradation, and stability and thickness of its fibrous cap. Plaques with a thin fibrous cap overlaying a large lipid core are at high risk for rupture. Plaque tends to be stable or fixed unevenly in any area of the coronary arteries. Calcified plaque tends to be stable and encased in a thrombus, until it begins to degrade. 3.Clients with ischemic coronary vessel disease and acute coronary syndrome (ACS) are classified as low or high risk for acute myocardial infarction based on characteristics that include significant: A) Heart murmurs B) ECG changes C) Pulmonary disease D) Pericardial effusion Ans: B Feedback: Persons with ischemic coronary vessel disease and ACS are routinely classified as low or high risk for acute myocardial infarction based on clinical history, ECG variables, and serum cardiac biomarkers. Chronic pulmonary disease increases pulmonary vascular resistance, leading to right or left heart failure. Pericardial effusion increases intracardiac pressure and venous pressure. Heart murmurs result from turbulent blood flow through a diseased valve. Page 1 Test Bank Chapter 19- Disorders of Cardiac Function 4.Which of the following individuals is suffering the effects of acute coronary syndrome (ACS)? A) A client whose most recent ECG indicates that silent myocardial ischemia has occurred B) A client who occasionally experiences persistent and severe chest pain when at rest C) A client who sometimes experiences chest pain when climbing stairs D) A client who has recently been diagnosed with variant (vasospastic) angina Ans: B Feedback: The onset of STEMI involves abrupt and significant chest pain. The pain typically is severe, often described as being constricting, suffocating, and crushing. Substernal pain that radiates to the left arm, neck, or jaw is common, although it may be experienced in other areas of the chest and back. Unlike that of angina, the pain associated with MI is more prolonged and not relieved by rest or nitroglycerin. Silent MI, stable angina, and variant, or vasospastic, angina are subtypes of chronic ischemic coronary artery disease. 5.A father experienced the onset of chest pain and dies suddenly. The family asks, “What caused him to die so suddenly?” The health care provider's reply that is most appropriate would be, “There's a high probability that your loved one developed an acute heart attack and experienced: A) Acute myocarditis.” B) High troponin levels.” C) Acute ventricular arrhythmia.” D) Hypertrophic cardiomyopathy.” Ans: C Feedback: Sudden death from an acute myocardial infarction in an adult is usually caused by fatal (ventricular) arrhythmias. Hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in the young, since the disorder can be inherited as an autosomal dominant trait. Troponin is normally present in cardiac muscle; serum levels of troponin enzymes are diagnostic and will elevate within 3 hours of the acute event. Myocarditis is inflammation of the heart muscle and conduction system without evidence of myocardial infarction. 6.The nurse would anticipate that which of the following clients would be considered a good candidate for coronary artery bypass grafting (CABG)? A) A 56-year-old with a history of MI experiencing new-onset chest pain and ST elevation B) A 24-year-old auto accident client diagnosed with pericardial effusion and cardiac tamponade C) A 87-year-old client admitted with uncontrolled dilated cardiomyopathy D) A 78-year-old client admitted with increasing fatigue related to aortic stenosis Page 2 Ans: A Feedback: Coronary artery bypass grafting (CABG) may be the treatment of choice for people with significant coronary artery disease (CAD) who do not respond to medical treatment and who are not suitable candidates for percutaneous coronary intervention. CABG does not address valve disorders, pericardial effusion, or cardiomyopathies. 7.On the 3rd day following an acute myocardial infarction, the client is being discharged home. The nurse is explaining how the heart tissue heals following an MI. “Since today is your 3rd day after your heart attack, the tissue is: A) Soft, mushy, and yellow.” B) Acutely inflamed.” C) Forming granulation tissue.” D) Developed a fibrous scar.” Ans: B Feedback: Approximately 2 to 3 days post–myocardial infarction, an acute inflammatory response develops in the area surrounding the necrotic tissue. The damaged area is gradually replaced with vascularized granulation tissue, which in turn becomes less vascular and more fibrous in composition. At 4 to 7 days, the center of the infarcted area is soft and yellow. By the 7th week, the necrotic area is completely replaced by fibrous scar tissue. 8.Chronic stable angina, associated with inadequate blood flow to meet the metabolic demands of the myocardium, is caused by: A) Fixed coronary obstruction B) Increased collateral circulation C) Intermittent vessel vasospasms D) Excessive endothelial relaxing factors Ans: A Feedback: Chronic stable angina is caused by fixed coronary obstruction that produces an imbalance between coronary blood flow and the metabolic demands of the myocardium. Endothelial relaxing factors relax the smooth muscle in the vessel wall and allow increased blood flow; treatment for chronic stable angina is with a vasodilating agent, such as nitroglycerine, that relaxes the vessels and enhances coronary blood flow. Intermittent vessel vasospasms, in conjunction with coronary artery stenosis, cause the vasospastic type of angina. Increased formation of collateral vessels is a compensatory response that allows adequate blood circulation to tissues distal to an obstruction. 9.Endocarditis and rheumatic heart disease are both cardiac complications of systemic infections. Characteristics include a new or changed heart murmur caused by: A) Chronic atrial fibrillation B) Myocardial inflammation