NCLEX-RN Practice Quiz Test Bank #3 (75 Questions), Exams of Biology

Download NCLEX-RN Practice Quiz Test Bank #3 (75 Questions) and more Exams Biology in PDF only on Docsity! NCLEX-RN Practice Quiz Test Bank #3 (75 Questions) NCLEXRN-03-001 Question Tag: Parkinson’s disease Question Category: Safe and Effective Care Environment, Management of Care A patient with Parkinson’s disease has a nursing diagnosis of Impaired Physical Mobility related to neuromuscular impairment. You observe a nursing assistant performing all of these actions. For which action must you intervene?  A. The NA assists the patient to ambulate to the bathroom and back to bed.  B. The NA reminds the patient not to look at his feet when he is walking.  C. The NA performs the patient’s complete bath and oral care.  D. The NA sets up the patient’s tray and encourages the patient to feed himself. Correct Answer: C. The NA performs the patient’s complete bath and oral care. The nursing assistant should assist the patient with morning care as needed, but the goal is to keep this patient as independent and mobile as possible.  Option A: Assisting the patient to ambulate prevents incidences of fall and injury.  Option B: Reminding the patient not to look at his feet while walking maintains the client’s independence while keeping him safe.  Option D: Encouraging the patient to feed himself is an appropriate goal of maintaining independence. NCLEXRN-03-002 Question Tag: low back pain Question Category: Health Promotion and Maintenance The nurse is preparing to discharge a patient with chronic low back pain. Which statement by the patient indicates that additional teaching is necessary?  A. “I will avoid exercise because the pain gets worse.”  B. “I will use heat or ice to help control the pain.”  C. “I will not wear high-heeled shoes at home or work.”  D. “I will purchase a firm mattress to replace my old one.” Correct Answer: A. “I will avoid exercise because the pain gets worse.” Exercises are used to strengthen the back, relieve pressure on compressed nerves and protect the back from re-injury. Doing exercises to strengthen the lower back can help alleviate and prevent lower back pain. It can also strengthen the core, leg, and arm muscles. According to researchers, exercise also increases blood flow to the lower back area, which may reduce stiffness and speed up the healing process.  Option B: Ice and heat application are appropriate interventions for back pain. Applying ice or a reusable gel pack constricts blood vessels and reduces swelling around the injury. This is particularly useful for conditions, like a sprained ankle, that cause significant swelling. Heat has the opposite effect, increasing blood flow to the area. This relaxes muscle fibers, which can help when the client experiences spasms or stiffness.  Option C: People with chronic back pain should avoid wearing high-heeled shoes at all times. The normal s-curve of the spine acts as a cushion or spring, reducing stress on the vertebrae. When wearing high heels, the shape of the spine is altered and the client doesn’t get that same shock absorption as she walks, which, over time, can lead to uneven wear on the cartilage discs, joints and ligaments of the back.  Option D: A firm mattress prevents lower back pain. Sleeping on a mattress that is too firm can cause aches and pains on pressure points. A medium-firm mattress may be more comfortable because it allows the NCLEXRN-03-005 Question Tag: Spinal cord injury Question Category: Physiological Integrity, Physiological Adaptation A patient with a spinal cord injury at level C3-4 is being cared for in the ED. What is the priority assessment?  A. Determine the level at which the patient has intact sensation.  B. Assess the level at which the patient has retained mobility.  C. Check blood pressure and pulse for signs of spinal shock.  D. Monitor respiratory effort and oxygen saturation level. Correct Answer: D. Monitor respiratory effort and oxygen saturation level. The first priority for the patient with an SCI is assessing respiratory patterns and ensuring an adequate airway. The patient with a high cervical injury is at risk for respiratory compromise because the spinal nerves (C3 – 5) innervate the phrenic nerve, which controls the diaphragm.  Option A: Determining this data can be done after addressing the concerns on the respiratory status of the patient.  Option B: This data can be assessed after monitoring the respiratory effort and oxygen saturation level of the patient.  Option C: Vital signs checking is also necessary, but not as high priority. Vital signs can be quite abnormal following SCI. In addition to the usual causes in trauma such as pain, bleeding and distress, this can be due to loss of autonomic control, which occurs particularly in cervical or high thoracic injuries. The autonomic nervous system controls our HR, BP temperature etc. Autonomic instability is most acute in the first few days to weeks of the injury. NCLEXRN-03-006 Question Tag: delegation Question Category: Safe and Effective Care Environment, Management of Care You are pulled from the ED to the neurologic floor. Which action should you delegate to the nursing assistant when providing nursing care for a patient with SCI?  A. Assess the patient’s respiratory status every 4 hours.  B. Take a patient’s vital signs and record them every 4 hours.  C. Monitor nutritional status including calorie counts.  D. Have the patient turn, cough, and deep breathe every 3 hours. Correct Answer: B. Take a patient’s vital signs and record them every 4 hours. The nursing assistant’s training and education include taking and recording a patient’s vital signs.  Option A: Assessing the patient’s respiratory status would require the knowledge of a registered nurse.  Option C: Monitoring patients requires additional education and is appropriate to the scope of practice for professional nurses.  Option D: The nursing assistant may assist with turning and repositioning the patient and may remind the patient to cough and deep breathe but does not teach the patient how to perform these actions. NCLEXRN-03-007 Question Tag: spinal cord injury Question Category: Basic Care and Comfort You are helping the patient with an SCI to establish a bladder-retraining program. What strategies may stimulate the patient to void? Select all that apply.  A. Stroke the patient’s inner thigh.  B. Pull on the patient’s pubic hair.  C. Initiate intermittent straight catheterization.  D. Pour warm water over the perineum.  E. Tap the bladder to stimulate detrusor muscle. Correct Answers: A, B, D, and E All of the strategies, except straight catheterization, may stimulate voiding in patients with SCI.  Option C: Intermittent bladder catheterization can be used to empty the patient’s bladder, but it will not stimulate voiding. NCLEXRN-03-008 Question Tag: cervical SCI Question Category: Safe and Effective Care Environment, Management of Care The patient with a cervical SCI has been placed in fixed skeletal traction with a halo fixation device. When caring for this patient the nurse may delegate which action (s) to the LPN/LVN? Select all that apply.  A. Check the patient’s skin for pressure from the device.  B. Assess the patient’s neurologic status for changes.  C. Observe the halo insertion sites for signs of infection.  D. Clean the halo insertion sites with hydrogen peroxide. Correct Answer: A, C, and D  Option A: Checking for signs of pressure within the scope of practice of the LPN/LVN. their nerve cells, causing muscle weakness and sometimes paralysis. GBS can cause symptoms that usually last for a few weeks.  Option D: The patient with C4 SCI is at risk for respiratory arrest. A C4 spinal cord injury occurs when damage is dealt about mid-way down the cervical spinal cord — the topmost portion of the spinal cord that is located in the neck and upper shoulders. NCLEXRN-03-011 Question Tag: multiple sclerosis Question Category: Physiological Integrity, Basic Care and Comfort The patient with multiple sclerosis tells the nursing assistant that after physical therapy she is too tired to take a bath. What is your priority nursing diagnosis at this time?  A. Fatigue related to disease state  B. Activity Intolerance due to generalized weakness  C. Impaired Physical Mobility related to neuromuscular impairment  D. Self-care Deficit related to fatigue and neuromuscular weakness Correct Answer: D. Self-care Deficit related to fatigue and neuromuscular weakness At this time, based on the patient’s statement, the priority is Self-Care Deficit related to fatigue after physical therapy. Fatigue is described as an overwhelming feeling of lassitude or lack of physical or mental energy that interferes with activities.  Option A: The patient might be experiencing fatigue, but it might be due to the activities at physical therapy. Fatigue is one of the most common symptoms of MS, reported by at least 75% of patients with the disease.  Option B: Activity intolerance in a patient with MS is appropriate, but not related to the statement. An estimated 50–60% of persons with MS describe fatigue as one of their most bothersome symptoms, and it is a major reason for unemployment among MS patients.  Option C: Impaired physical mobility is appropriate to a patient with MS, but it is not related to the patient’s statement. Spasticity in MS is characterized by increased muscle tone and resistance to movement; it occurs most frequently in muscles that function to maintain upright posture. The muscle stiffness greatly increases the energy expended to perform activities of daily living (ADLs), which in turn contributes to fatigue. NCLEXRN-03-012 Question Tag: GBS Question Category: Physiological Integrity, Reduction of Risk Potential The LPN/LVN, under your supervision, is providing nursing care for a patient with GBS. What observation would you instruct the LPN/LVN to report immediately?  A. Complaints of numbness and tingling.  B. Facial weakness and difficulty speaking.  C. Rapid heart rate of 102 beats per minute.  D. Shallow respirations and decreased breath sounds. Correct Answer: D. Shallow respirations and decreased breath sounds The priority interventions for the patient with GBS are aimed at maintaining adequate respiratory function. These patients are at risk for respiratory failure, which is urgent. Upon presentation, 40% of patients have respiratory or oropharyngeal weakness. Ventilatory failure with required respiratory support occurs in up to one third of patients at some time during the course of their disease.  Option A: These findings should be reported to the nurse but it is not an urgent matter. The typical patient with Guillain-Barré syndrome (GBS), which in most cases will manifest as acute inflammatory demyelinating polyradiculoneuropathy (AIDP), presents 2-4 weeks following a relatively benign respiratory or gastrointestinal illness with complaints of finger dysesthesias and proximal muscle weakness of the lower extremities.  Option B: Facial weakness and difficulty of speaking are common signs of GBS and must be reported, but it is not a priority. The classic clinical picture of weakness is ascending and symmetrical in nature. The lower limbs are usually involved before the upper limbs. Proximal muscles may be involved earlier than the more distal ones. Trunk, bulbar, and respiratory muscles can be affected as well.  Option C: A rapid heart rate is important and should be reported to the nurse, but it is not life-threatening. Autonomic nervous system involvement with dysfunction in the sympathetic and parasympathetic systems can be observed in patients with GBS. NCLEXRN-03-013 Question Tag: myasthenia gravis Question Category: Physiological Adaptation The nursing assistant reports to you, the RN, that the patient with myasthenia gravis (MG) has an elevated temperature (102.20 F), heart rate of 120/minute, rise in blood pressure (158/94), and was incontinent of urine and stool. What is your best first action at this time?  A. Administer an acetaminophen suppository  B. Notify the physician immediately  C. Recheck vital signs in 1 hour  D. Reschedule patient’s physical therapy session Correct Answer: B. Notify the physician immediately. The changes that the nursing assistant is reporting are characteristics of myasthenia crisis, which often follows some type of infection. The patient is at risk for inadequate respiratory function. In addition to notifying the physician, the nurse should carefully monitor the patient’s respiratory status. The patient may need intubation and mechanical ventilation.  Option B: They often ignore the food on the left side of their food trays, so reminding them is a correct action.  Option C: Passive range of motion exercises help keep the left side of the patient’s body from atrophy as a result of unuse.  Option D: This is a correct action of the student nurse, as the patient may neglect the left side of the body. NCLEXRN-03-016 Question Tag: arteries Question Category: Physiological Integrity, Physiological Adaptation 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 Correct Answer: C. Left anterior descending artery The left anterior descending artery is the primary source of blood for the anterior wall of the heart. The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left side of the heart.  Option A: The circumflex artery supplies the lateral wall. The circumflex artery, fully titled as the circumflex branch of the left coronary artery, is an artery that branches off from the left coronary artery to supply portions of the heart with oxygenated blood. The circumflex artery itself divides into smaller arterial systems.  Option B: The internal mammary artery supplies the mammary. The internal thoracic artery (ITA), previously commonly known as the internal mammary artery (a name still common among surgeons), is an artery that supplies the anterior chest wall and the breasts.  Option D: The right coronary artery supplies the inferior wall of the heart. The right coronary artery supplies blood to the right ventricle and then supplies the underside (inferior wall) and backside (posterior wall) of the left ventricle. NCLEXRN-03-017 Question Tag: coronary arteries Question Category: Physiological Integrity, Physiological Adaptation When do coronary arteries primarily receive blood flow?  A. During inspiration  B. During diastole  C. During expiration  D. During systole Correct Answer: 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.  Option A: Breathing patterns are irrelevant to blood flow. It has been suggested that the diaphragm will preferentially steal blood flow from working locomotor muscles during increased activity (Bradley & Leith, 1978; Musch, 1993). In healthy adults, the cost of breathing is <5% of the total oxygen consumption at low level exercise but approaches 15% during heavy exercise in young athletes or older fit subjects (Aaron et al. 1992; Dempsey & Johnson, 1992). Further, a reflex vasoconstriction of the locomotor muscles is evident when a substantial respiratory load is applied sufficient to elicit diaphragm fatigue  Option C: Expiration is not related to the blood flow. The pulmonary system is intimately linked with the cardiovascular system anatomically and hemodynamically and plays a significant role in exercise intolerance through a number of mechanisms (Olson et al. 2006a,b;).  Option D: There is a little portion of the blood that the coronary arteries receive during systole. During systole, intramuscular blood vessels are compressed and twisted by the contracting heart muscle and blood flow to the left ventricle is at its lowest. The force is greatest in the subendocardial layers where it approximates to intramyocardial pressure. NCLEXRN-03-018 Question Tag: cause of death Question Category: Health Promotion and Maintenance 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 Correct Answer: B. Coronary artery disease Coronary artery disease accounts for over 50% of all deaths in the US.  Option A: Cancer accounts for approximately 20%.  Option C: Liver failure accounts for less than 10% of all deaths in the US.  Option D: Less than 10% of all deaths in the US can be attributed to renal failure. NCLEXRN-03-019 Question Tag: coronary artery disease Question Category: Physiological Integrity, Physiological Adaptation NCLEXRN-03-021 Question Tag: coronary artery disease Question Category: Health Promotion and Maintenance Which of the following risk factors for coronary artery disease cannot be corrected?  A. Cigarette smoking  B. DM  C. Heredity  D. HPN Correct Answer: C. Heredity Because “heredity” refers to our genetic makeup, it can’t be changed.  Option A: Cigarette smoking cessation is a lifestyle change that involves behavior modification. Smoking raises the risk of getting CAD and dying early from CAD. Carbon monoxide, nicotine, and other substances in tobacco smoke can promote atherosclerosis and trigger symptoms of coronary artery disease.  Option B: Diabetes mellitus is a risk factor that can be controlled with diet, exercise, and medication. Over time, high blood sugar can damage blood vessels and the nerves that control the heart. People with diabetes are also more likely to have other conditions that raise the risk for heart disease: High blood pressure increases the force of blood through your arteries and can damage artery walls.  Option D: Altering one’s diet, exercise, and medication can correct hypertension. British Hypertension Society (BHS) guidelines state that advice should be provided for prevention as well as treatment of hypertension and should be given to pre-hypertensives and those with a strong family history. They point out that effective lifestyle modification can lower blood pressure by at least as much as a single antihypertensive drug. NCLEXRN-03-022 Question Tag: cholesterol, coronary artery disease Question Category: Physiological Integrity, Reduction of Risk Potential 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 Correct Answer: 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. Normal levels of serum cholesterol is within 125 to 200 mg/dl.  Option A: 100 mg/dl is an acceptable level of serum cholesterol. An elevated low-density lipoprotein cholesterol (LDL-C) level is a major risk factor for CAD, and several large, randomized, primary prevention trials have shown that lowering LDL-C levels with statins reduces the risk of major coronary events and coronary death.  Option B: 150 mg/dl is within the normal level of serum cholesterol. LDL is the particle that is responsible for transporting cholesterol to tissues. Cholesterol transportation is achieved by binding of the LDL receptor and apoB.  Option C: 175 mg/dl is still an acceptable level of serum cholesterol. HDL is a molecule that is antioxidant, antiinflammatory, antiapoptotic and increases macrophage cholesterol excretion and endothelial healing. The removal of cholesterol from the body by the liver via HDL is called reverse cholesterol transport. NCLEXRN-03-023 Question Tag: coronary artery disease Question Category: Physiological Integrity, Physiological Adaptation 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 sublingual nitroglycerin  D. Educate the client about his symptoms Correct Answer: B. Enhance myocardial oxygenation Enhancing myocardial oxygenation is always the first priority when a client exhibits signs and symptoms of cardiac compromise. Without adequate oxygen, the myocardium suffers damage.  Option A: Decreasing the client’s anxiety is also important, but it is not the priority. When someone is anxious, their body reacts in ways that can put an extra strain on their heart. The physical symptoms of anxiety can be especially damaging among individuals with existing cardiac disease.  Option C: Sublingual nitroglycerin is administered to treat acute angina, but its administration isn’t the first priority. Although nitroglycerin has a vasodilatory effect in both arteries and veins, the profound desired effects caused by nitroglycerin are primarily due to venodilation. Venodilation causes pooling of blood within the venous system, reducing preload to the heart, which causes a decrease in cardiac work, reducing anginal symptoms secondary to demand ischemia.  Option D: Although educating the client is important in care delivery, it is not a priority when a client is compromised. Patient education promotes patient-centered care and increases adherence to medication and treatments. An increase in compliance leads to a more efficient and cost- effective healthcare delivery system. Educating patients ensures continuity of care and reduces complications related to the illness. NCLEXRN-03-026 Question Tag: myocardial infarction Question Category: Physiological Integrity, Physiological Adaptation Which of the following is the most common symptom of myocardial infarction?  A. Chest pain  B. Dyspnea  C. Edema  D. Palpitations Correct Answer: A. Chest pain The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. The classic manifestation of ischemia is usually described as a heavy chest pressure or squeezing, a “burning” feeling, or difficulty in breathing. The discomfort or pain often radiates to the left shoulder, neck, or arm. Chest pain may be atypical in a few cases. It builds in intensity over a period of a few minutes.  Option B: Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI. Despite variable prevalence estimates, dyspnea has been consistently associated with greater mortality in the general population. It is a more powerful predictor of clinical outcomes than objective physiologic measures such as pulmonary function testing in the general population, or angina in patients referred for cardiac evaluation.  Option C: Edema is a later sign of heart failure, often seen after an MI. All the factors which contribute to increased pressure in the left side and pooling of blood on the left side of the heart can cause cardiogenic pulmonary edema. The result of all these conditions will be increased pressure on the left side of the heart: increased pulmonary venous pressure–> increased capillary pressure in lungs–> pulmonary edema.  Option D: Palpitations may result from reduced cardiac output, producing arrhythmias. In patients who describe the palpitations as a brief flip- flopping in the chest, the palpitations are thought to be caused by extra systoles such as supraventricular or ventricular premature contractions. The flip-flop sensation is thought to result from the forceful contraction following the pause and the sensation that the heart is stopped results from the pause. The sensation of rapid fluttering in the chest is thought to result from a sustained ventricular or supraventricular arrhythmia. NCLEXRN-03-027 Question Tag: apical pulse Question Category: Physiological Integrity, Physiological Adaptation Which of the following landmarks is the correct 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 Correct Answer: 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.  Option A: Normally, heart sounds aren’t heard in the midaxillary line. During systolic contraction of the heart, a high amplitude wave of blood gets ejected through the aortic valve out towards the periphery. This high- pressure wave distends the arteries, especially compliant “elastic” or “conducting” arteries, which tend to be larger and closer to the heart. The subsequent release of that distention somewhat sustains the systolic wave of blood throughout the body, creating a spike followed by a downward sloping plateau in pulse waveform.  Option C: The left second intercostal space in the midclavicular line is where the pulmonic sounds are auscultated. The intensity of the pulse is determined by blood pressure as well as other physiological factors such as ambient temperature. For example, colder temperatures cause vasoconstriction leading to decreased intensity. Besides the normal variation in a rhythm that occurs with the respiratory cycle, the heart rate should be regular in the absence of pathology.  Option D: Heart sounds are not heard in the seventh intercostal space in the midclavicular line. Pulses are accurately measured when the clinician places their fingertips onto the skin overlying the vessel (locations, see below) and focuses on different aspects of the pulse. (NB: although one often hears that utilization of the thumb for measuring pulses is less accurate secondary to increased perception of the clinician’s own pulsation during palpation, the author could not find data to support or refute this claim). If possible, the limb under evaluation should have support throughout palpation. NCLEXRN-03-028 Question Tag: pain Question Category: Physiological Integrity, Physiological Adaptation 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 Correct Answer: D. Pulmonary Pulmonary pain is generally described by these symptoms. Pain may originate from several different structures within the chest, including the skin, ribs, intercostal muscles, pleura, esophagus, heart, aorta, diaphragm, or thoracic NCLEXRN-03-030 Question Tag: cardiac damage Question Category: Physiological Integrity, Reduction of Risk Potential 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 Correct Answer: 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. The troponin complex consists of three subunits—troponin C, troponin I, and troponin T—and is located on the myofibrillar thin (actin) filament of striated (skeletal and cardiac) muscle. The cardiac isoforms troponin T and I are only expressed in cardiac muscle. Hence, cardiac troponin T (cTnT) and I (cTnI) are more specific than creatine kinase (CK) values for myocardial injury and, because of their high sensitivity, they may even be elevated when CK‐MB concentrations are not.  Option A: Lactate dehydrogenase is present in almost all body tissues and not specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. The function of the enzyme is to catalyze the reversible conversion of lactate to pyruvate with the reduction of NAD+ to NADH and vice versa.  Option B: CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes. Obtain a complete blood cell (CBC) count if myocardial infarction (MI) is suspected in order to rule out anemia as a cause of decreased oxygen supply and prior to giving thrombolytic agents.  Option D: Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury. In their current guidelines from 2000, the Joint European Society of Cardiology/American College of Cardiology committee redefined AMI as an elevation of cTn in blood above the 99th centile of a healthy reference population in conjunction with signs or symptoms of ischaemia. This did expand the diagnostic capacity to detect micro‐MI which was not evident by CK‐MB measurements. NCLEXRN-03-031 Question Tag: morphine, myocardial infarction Question Category: Physiological Integrity, Pharmacological and Parenteral therapies 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 Correct Answer: D. To decrease oxygen demand on the client’s heart Morphine is administered because it decreases myocardial oxygen demand. Morphine to relieve pain during a myocardial infarction (MI) has been in use since the early 1900s. In 2005, an observational study raised some concerns, but there are very few effective alternatives. Morphine is a potent opioid; it decreases pain, which in turn leads to a decrease in the activation of the autonomic nervous system. These are desirable effects when a patient is having an MI.  Option A: Morphine can also cause sedation on the client, but it is not the main purpose of administering it. Morphine is rarely used for procedural sedation. However, for small procedures, physicians will sometimes combine a low dose of morphine with a low dose of benzodiazepine-like lorazepam.  Option B: Pain is decreased when morphine is given, but it is not the primary reason for administration. FDA-approved usage of morphine sulfate includes moderate to severe pain that may be acute or chronic. Most commonly used in pain management, morphine provides significant relief to patients afflicted with pain.  Option C: Morphine will also decrease anxiety, but isn’t primarily given for this reason. Morphine can decrease the heart rate, blood pressure, and venous return. Morphine can also stimulate local histamine-mediated processes. NCLEXRN-03-032 Question Tag: myocardial infarction Question Category: Physiological Integrity, Physiological Adaptation Which of the following conditions is most commonly responsible for myocardial infarction?  A. Aneurysm  B. Heart failure  C. Coronary artery thrombosis  D. Renal failure Correct Answer: C. Coronary artery thrombosis Coronary artery thrombosis causes occlusion of the artery, leading to myocardial death. Myocardial infarction occurs when a coronary artery is so severely blocked that there is a significant reduction or break in the blood supply, causing damage or death to a portion of the myocardium (heart muscle).  Option A: An aneurysm is an outpouching of a vessel and doesn’t cause an MI. On exertion, an elevated blood pressure could cause expansion of the aneurysmal cavity, aggravating the coronary ischemia, and eventually would have produced myocardial infarction. However, this only occurs in very rare cases.  Option A: Mechanical changes are those that affect the pumping action of the heart. The main mechanical complications (MC) of acute myocardial infarction are ventricular septal rupture(VSR), free wall rupture (FWR), and ischemic mitral regurgitation (IMR). In the chronic phase, negative remodeling and aneurysm formation may occur.  Option B: Hematologic changes would affect the blood. It has been documented that WBC associates through coronary atherosclerosis and ESR in myocardial infarction. Variations occur in hematological parameters such as hemoglobin, WBC, ESR, and platelet sedimentation rate and fibrinogen in acute myocardial infarction.  Option C: Electrophysiologic changes affect conduction. When coronary blood flow is inadequate to support the oxygen needs of the myocardium (i.e., an ischemic state), tissue levels of oxygen fall, which leads to cellular hypoxia. Severe and prolonged hypoxia can ultimately lead to cellular death and total loss of electrical activity. Less severe hypoxia, or hypoxia of relatively short duration, will produce electrophysiological (and mechanical) changes in the heart. NCLEXRN-03-035 Question Tag: heart sounds Question Category: Physiological Integrity, Physiological Adaptation 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 Correct Answer: A. Ventricular dilation Rapid filling of the ventricles causes vasodilation that is auscultated as S3. The third heart sound (S3) is a low-frequency, brief vibration occurring in early diastole at the end of the rapid diastolic filling period of the right or left ventricle  Option B: Systemic hypertension can result in a fourth heart sound. The fourth heart sound is a low-pitched sound coincident with late diastolic filling of the ventricle due to atrial contraction. It thus occurs shortly before the first heart sound. Although it is also called the atrial sound, and its production requires an effective atrial contraction, the fourth heart sound is the result of vibrations generated within the ventricle.  Option C: Aortic valve malfunction is heard as a murmur. One in three elderly people have a heart murmur because of the scarring, thickening, or stiffening of their aortic valve. That’s aortic sclerosis. It’s usually not dangerous, since the valve can work for years after the murmur starts.  Option D: Increased atrial contractions can cause a fourth heart sound. Common theoretic mechanisms for this condition are based around abnormal automaticity of the cardiac myocytes, increased eliciting events from chemical or physical instigators, and reentry of a retrograde impulse. For these causes, structural heart damage or chemical use may be found during the history and physical examination. NCLEXRN-03-036 Question Tag: crackles Question Category: Physiological Integrity, Physiological Adaptation 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 Correct Answer: A. Left-sided heart failure The left ventricle is responsible for the most 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.  Option B: Pulmonic valve malfunction may cause right-sided heart failure. Pulmonary regurgitation (PR, also called pulmonic regurgitation) is a leaky pulmonary valve. This valve helps control the flow of blood passing from the right ventricle to the lungs. A leaky pulmonary valve allows blood to flow back into the heart chamber before it gets to the lungs for oxygen.  Option C: Right-sided heart failure can be caused by pulmonic valve or tricuspid valve malfunction. This is narrowing of the pulmonic valve that limits blood flow out of the right ventricle.  Option D: Tricuspid valve malfunction causes right-sided heart failure. The tricuspid valve doesn’t close properly. This causes blood in the right ventricle to flow back into the right atrium. NCLEXRN-03-037 Question Tag: myocardial damage Question Category: Physiological Integrity, Reduction of Risk Potential 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 Correct Answer: D. Electrocardiogram The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial infarction. NCLEXRN-03-040 Question Tag: ischemic myocardium Question Category: Physiological Integrity, Pharmacological and Parenteral therapies 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 Correct Answer: 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.  Option B: Calcium channel blockers reduce the workload of the heart by decreasing the heart rate.  Option C: Narcotics reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety.  Option D: Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload). NCLEXRN-03-041 Question Tag: myocardial infarction Question Category: Physiological Integrity, Physiological Adaptation What is the most common complication of a myocardial infarction?  A. Cardiogenic shock  B. Heart failure  C. Arrhythmias  D. Pericarditis Correct Answer: C. Arrhythmias Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI.  Option A: 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.  Option B: Because the pumping function of the heart is compromised by an MI, heart failure is the second most common complication.  Option D: Pericarditis most commonly results from a bacterial or viral infection but may occur after MI. NCLEXRN-03-042 Question Tag: jugular vein distention Question Category: Physiological Integrity, Physiological Adaptation With which of the following disorders is jugular vein distention most prominent?  A. Abdominal aortic aneurysm  B. Heart failure  C. Myocardial infarction  D. Pneumothorax Correct Answer: B. Heart failure Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump.  Option A: Jugular vein distention isn’t a symptom of abdominal aortic aneurysm. The jugular vein is considered a central vein in the body. Central veins are thin-walled, distensible reservoirs and act as a conduit of blood in continuity with the right atrium. The jugular vein divides into external and internal.  Option C: An MI, if severe enough, can progress to heart failure; however, in and of itself, an MI doesn’t cause jugular vein distention. In patients with acute inferior-wall MI with right ventricular involvement, distention of neck veins is commonly described as a sign of failure of the right ventricle.  Option D: Pneumothorax does not cause jugular vein distention. A tension pneumothorax can cause severe hypotension (obstructive shock) and even death. An increase in central venous pressure can result in distended neck veins, hypotension. NCLEXRN-03-043 Question Tag: jugular vein distention Question Category: Physiological Integrity, Physiological Adaptation 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 Correct Answer: 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.  Option A: In high-Fowler’s position, the veins would be barely discernible above the clavicle. NCLEXRN-03-046 Question Tag: heart failure Question Category: Physiological Integrity, Physiological Adaptation Which of the following symptoms is most commonly associated with left-sided heart failure?  A. Crackles  B. Arrhythmias  C. Hepatic engorgement  D. Hypotension Correct Answer: 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. The left ventricle of the heart no longer pumps enough blood around the body. As a result, blood builds up in the pulmonary veins (the blood vessels that carry blood away from the lungs). This causes shortness of breath, trouble breathing or coughing – especially during physical activity. Left-sided heart failure is the most common type.  Option B: Arrhythmias can be associated with both right and left-sided heart failure. Cardiac arrhythmia is an abnormal rate and/or rhythm of a heart due to its abnormal electrical impulse origination and/or propagation. Various etiologies can cause arrhythmias. Heart failure (HF) is a clinical syndrome due to an impaired heart that can not pump sufficient blood to meet the systemic metabolic needs.  Option C: Hepatomegaly is prominent with chronic right-sided heart failure. The primary pathophysiology involved in hepatic dysfunction from HF is either passive congestion from increased filling pressures or low cardiac output and the consequences of impaired perfusion. Passive hepatic congestion due to increased central venous pressure may cause elevations of liver enzymes and both direct and indirect serum bilirubin.  Option D: Left-sided heart failure causes hypertension secondary to an increased workload on the system. Hypertension increases the workload on the heart inducing structural and functional changes in the myocardium. These changes include hypertrophy of the left ventricle, which can progress to heart failure. NCLEXRN-03-047 Question Tag: sacral edema Question Category: Physiological Integrity, Physiological Adaptation In which of the following disorders would the nurse expect to assess sacral edema in bedridden client?  A. DM  B. Pulmonary emboli  C. Renal failure  D. Right-sided heart failure Correct Answer: D. Right-sided heart failure The most accurate area of the body to assess dependent edema in a bedridden client is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure.  Option A: Diabetes mellitus is not directly related to sacral edema. Insulin edema is uncommon, and the extent of oedema may vary from limited ankle swelling to severe.  Option B: Pulmonary emboli does not cause sacral edema. Sacral edema accumulates in the lower back (called sacral edema) after being in bed for several hours. Pushing on the swollen area for a few seconds will leave a temporary dimple or dent in the skin.  Option C: Renal disease isn’t directly linked to sacral edema. When edema is massive and generalized, it is called anasarca. It is caused by a variety of clinical conditions like heart failure, renal failure, liver failure, or problems with the lymphatic system. NCLEXRN-03-048 Question Tag: right-sided heart failure Question Category: Physiological Integrity, Physiological Adaptation Which of the following symptoms might a client with right-sided heart failure exhibit?  A. Adequate urine output  B. Polyuria  C. Oliguria  D. Polydipsia Correct Answer: C. Oliguria Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Oliguria is a late finding in heart failure, and it is found in patients with markedly reduced cardiac output from severely reduced LV function.  Option A: An adequate urine output indicates that the client does not have fluid retention. The activation of the RAAS leads to salt and water retention, resulting in increased preload and further increases in myocardial energy expenditure. This results in an increase in angiotensin II (Ang II) levels and, in turn, aldosterone levels, causing stimulation of the release of aldosterone. Ang II, along with ET-1, is crucial in maintaining effective intravascular homeostasis as mediated by vasoconstriction and aldosterone-induced salt and water retention.  Option B: Polyuria is possible in a weak heart due to heart failure. A weak heart cannot pump blood efficiently, causing fluids to build up in the body. The kidneys work to rid the body of excess fluid, causing frequent urination. NCLEXRN-03-051 Question Tag: heart failure Question Category: Physiological Integrity, Physiological Adaptation 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 Correct Answer: D. Right-sided heart failure Weight gain, nausea, and a decrease in urine output are secondary effects of right-sided heart failure. Here the right ventricle of the heart is too weak to pump enough blood to the lungs. This causes blood to build up in the veins (the blood vessels that carry blood from the organs and tissue back to the heart). The increased pressure inside the veins can push fluid out of the veins into surrounding tissue. This leads to a build-up of fluid in the legs, or less commonly in the genital area, organs or the abdomen (belly).  Option A: Angina pectoris doesn’t cause weight gain, nausea, or a decrease in urine output. Angina is chest pain or discomfort caused when the heart muscle doesn’t get enough oxygen-rich blood. It may feel like pressure or squeezing in the chest. The discomfort also can occur in the shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.  Option B: Cardiomyopathy is usually identified as a symptom of left-sided heart failure. The left ventricle of the heart no longer pumps enough blood around the body. As a result, blood builds up in the pulmonary veins (the blood vessels that carry blood away from the lungs). This causes shortness of breath, trouble breathing or coughing – especially during physical activity. Left-sided heart failure is the most common type.  Option C: Left-sided heart failure causes primarily pulmonary symptoms rather than systemic ones. Left-sided heart failure is usually caused by coronary artery disease (CAD), a heart attack or long-term high blood pressure. NCLEXRN-03-052 Question Tag: abdominal aortic aneurysm Question Category: Physiological Integrity, Physiological Adaptation What is the most common cause of abdominal aortic aneurysm?  A. Atherosclerosis  B. DM  C. HPN  D. Syphilis Correct Answer: 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. AAA is thought to be a degenerative process of the aorta, the cause of which remains unclear. It is often attributed to atherosclerosis because these changes are observed in the aneurysm at the time of surgery.  Option B: Diabetes mellitus does not directly cause abdominal aortic aneurysm. Patients at greatest risk for AAA are men who are older than 65 years and have peripheral atherosclerotic vascular disease. A history of smoking often is elicited.  Option C: Hypertension accounts for 1-15% cases of abdominal aneurysm. A Swedish study showed that instances of AAA in elderly men have been decreasing, A phenomenon that can be attributed to a nationwide decline in smoking for the past 30 years, as well as the significantly improved longevity of the elderly population.  Option D: Syphilis is not related to AAA. Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on your genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores. NCLEXRN-03-053 Question Tag: abdominal aortic aneurysm Question Category: Physiological Integrity, Physiological Adaptation 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 Correct Answer: 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.  Option A: Distal to the iliac arteries, the vessel is again surrounded by stable vasculature, making this an uncommon site for an aneurysm.  Option C: There is no area adjacent to the aortic arch, which bends into the thoracic (descending) aorta.  Option D: The proximal portion is surrounded by stable structures, lessening the risk for rupture. NCLEXRN-03-056 Question Tag: abdominal aortic aneurysm Question Category: Physiological Integrity, Physiological Adaptation 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 Correct Answer: D. Lower back pain Lower back pain results from expansion of an aneurysm. The expansion applies pressure in the abdominal cavity, and the pain is referred to the lower back.  Option A: Abdominal pain is the most common symptom resulting from impaired circulation. The most typical manifestation of rupture is abdominal or back pain with a pulsatile abdominal mass. However, the symptoms may be vague, and the abdominal mass may be missed.  Option B: Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in peripheral vascular disease.  Option C: Angina is associated with atherosclerosis of the coronary arteries. NCLEXRN-03-057 Question Tag: abdominal aortic aneurysm Question Category: Physiological Integrity, Reduction of Risk Potential What is the definitive test used to diagnose an abdominal aortic aneurysm?  A. Abdominal X-ray  B. Arteriogram  C. CT scan  D. Ultrasound Correct Answer: B. Arteriogram An arteriogram accurately and directly depicts the vasculature; therefore, it clearly delineates the vessels and any abnormalities.  Option A: An abdominal aneurysm would only be visible on an X-ray if it were calcified. Plain radiography is often performed on patients with abdominal complaints before the diagnosis of AAA has been entertained. Using this method to evaluate patients with AAA is difficult because the only marginally specific finding, aortic wall calcification, is seen less than half of the time. Aortic-wall calcification (see the images below) may appear without aneurysm rim calcification, resulting in a high false- negative rate.  Option C: CT scan doesn’t give a direct view of the vessels. CT permits visualization of the retroperitoneum, is not limited by obesity or bowel gas, detects leakage, and allows concomitant evaluation of the kidneys.  Option D: Ultrasound doesn’t yield as accurate a diagnosis as the arteriogram. Ultrasonography is the standard imaging tool for AAA. When performed by trained personnel, it has a sensitivity of nearly 100% and a specificity approaching 96% for the detection of infrarenal AAA. NCLEXRN-03-058 Question Tag: abdominal aneurysm Question Category: Physiological Integrity, Reduction of Risk Potential Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm client?  A. HPN  B. Aneurysm rupture  C. Cardiac arrhythmias  D. Diminished pedal pulses Correct Answer: B. Aneurysm rupture Rupture of an aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this type of client. The layers of the aortic wall can also separate (aortic dissection). This produces severe, tearing pain in the chest, back or abdomen. The potential for rupture is the most serious risk associated with an aortic aneurysm. A ruptured aortic aneurysm can cause life- threatening internal bleeding and/or a stroke.  Option A: Hypertension should be avoided and controlled because it can cause the weakened vessel to rupture. Hypertension has been considered a potential risk factor for AAA; but the findings from prospective cohort studies have not been entirely consistent, nor have they been summarised in a comprehensive meta-analysis.  Option D: Diminished pedal pulses, a sign of poor circulation to the lower extremities, are associated with an aneurysm but aren’t life-threatening. The appearance of microembolic lower limb infarcts in a patient with easily palpable pedal pulses may suggest the presence of either popliteal or abdominal aneurysms.  Option C: Cardiac arrhythmias aren’t directly linked to an aneurysm. Ventricular aneurysms may cause shortness of breath, chest pain, or an irregular heart beat (arrhythmia). NCLEXRN-03-059 Question Tag: aneurysm Question Category: Physiological Integrity, Physiological Adaptation Which of the following blood vessel layers may be damaged in a client with an aneurysm? Correct Answer: B. HPN Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur. The association between hypertension and AAA could potentially be confounded by other risk factors because hypertension is more common among persons with overweight and obesity, less physical activity, who smoke and who have unhealthy diets.  Option A: Diabetes mellitus doesn’t have a direct link to aneurysm. Diabetes mellitus (DM) is a strong cardiovascular risk factor; however, multiple epidemiological studies have confirmed that a negative relationship exists between DM and abdominal aortic aneurysm (AAA) presence, growth and rupture. Arteries from patients with DM are often harder and more calcified than those from patients without DM; however, increased vessel wall calcification alone does not appear to explain the reduced rate of aortic expansion seen in diabetic patients.  Option C: 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.  Option D: Only 1% of clients with syphilis experience an aneurysm. Classically, syphilitic aneurysms occur in 90% of cases on the thoracic aorta, and in 10% in the abdominal aorta [3, 7–9]. Infection of the aortic wall develops during the secondary or bacteraemic phase of syphilis, having a latent period from infection until the clinical presentation ranging from 5 to 50 years. NCLEXRN-03-062 Question Tag: auscultation Question Category: Health Promotion and Maintenance 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 Correct Answer: A. Bruit A bruit, a vascular sound resembling heart murmur, suggests partial arterial occlusion. In addition to abdominal palpation, auscultation for abdominal or femoral bruits may be useful for clinical detection of AAA. Auscultation is performed along the course of the aortic and femoral arteries. However, absence of a bruit does not exclude an aneurysm.  Option B: Crackles are indicative of fluid in the lungs. Crackles occur if the small air sacs in the lungs fill with fluid and there’s any air movement in the sacs, such as when breathing. The air sacs fill with fluid when a person has pneumonia or heart failure.  Option C: Dullness is heard over solid organs, such as the liver. Dull or thud like sounds are normally heard over dense areas such as the heart or liver. Dullness replaces resonance when fluid or solid tissue replaces air- containing lung tissues, such as occurs with pneumonia, pleural effusions, or tumors  Option D: Friction rubs indicate inflammation of the peritoneal surface. A pericardial friction rub is pathognomonic for acute pericarditis; the rub has a scratching, grating sound similar to leather rubbing against leather. Serial examinations may be necessary for detection, as a friction rub may be transient from one hour to the next and is present in approximately 50% of cases. NCLEXRN-03-063 Question Tag: ruptured abdominal aneurysm Question Category: Physiological Integrity, Physiological Adaptation 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 Correct Answer: 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 has decreased – not increased. The WBC count increases as cells migrate to the site of injury.  Option A: The pain felt during rupture is severe. Due to the loss of blood, the blood pressure decreases.  Option C: The WBC count increases because the cells migrate to the site of injury.  Option D: The pain is not intermittent during an aneurysm; it is constant and severe. NCLEXRN-03-064 Question Tag: hematoma Question Category: Physiological Integrity, Reduction of Risk Potential 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 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 Correct Answer: D. Surgical intervention When the vessel ruptures, surgery is the only intervention that can repair it. The techniques used for aneurysm surgery have for long been standardized. 95% of aneurysms are accessible via a small frontotemporal craniotomy centred over the pterion. Only occasional cases, principally aneurysms of the distal anterior cerebral artery and the lower vertebrobasilar trunk, require different surgical approaches.  Option A: Administration of antihypertensive medications can help control hypertension, reducing the risk of rupture. Normalization of blood pressure by hydralazine significantly reduced the incidence of ruptured aneurysms and the rupture rate. There was a dose dependent relationship between the reduction of blood pressure and the prevention of aneurysmal rupture. Captopril and losartan were able to reduce the rupture rates without affecting systemic hypertension induced by DOCA-salt treatment.  Option B: An aortogram is a diagnostic tool used to detect an aneurysm. An aortogram is an invasive diagnostic test using a catheter to inject dye (contrast medium) into the aorta. X-rays are taken of the dye as it travels within the aorta, allowing clear visualization of blood flow. This way, any structural abnormalities of the aorta will be accurately seen.  Option C: Beta blockers can slow the heartbeat, thereby decreasing blood pressure. Antihypertensives are used to reduce the rate of rise of the aortic pressure (dP/dt). For acute reduction of arterial pressure, the potent vasodilator sodium nitroprusside is very effective. To reduce dP/dt acutely, administer a beta blocker intravenously (IV) in incremental doses until a heart rate of 60-80 beats/min is attained. When beta blockers are contraindicated, as in second- or third-degree atrioventricular block, consider using calcium-channel blockers. NCLEXRN-03-067 Question Tag: cardiovascular diseases Question Category: Physiological Integrity, Reduction of Risk Potential Which of the following heart muscle diseases is unrelated to other cardiovascular diseases?  A. Cardiomyopathy  B. Coronary artery disease  C. Myocardial infarction  D. Pericardial Effusion Correct Answer: A. Cardiomyopathy Cardiomyopathy isn’t usually related to an underlying heart disease such as atherosclerosis. The etiology in most cases is unknown.  Option B: Coronary artery disease is directly related to atherosclerosis. Coronary artery disease is caused by plaque buildup in the wall of the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes the inside of the arteries to narrow over time. This process is called atherosclerosis.  Option C: During progression of atherosclerosis, myeloid cells destabilize lipid-rich plaque in the arterial wall and cause its rupture, thus triggering myocardial infarction.  Option D: Pericardial effusion is the escape of fluid into the pericardial sac, a condition associated with pericarditis and advanced heart failure. NCLEXRN-03-068 Question Tag: cardiomyopathy Question Category: Physiological Integrity, Physiological Adaptation Which of the following types of cardiomyopathy can be associated with childbirth?  A. Dilated  B. Hypertrophic  C. Myocarditis  D. Restrictive Correct Answer: A. Dilated Although the cause isn’t entirely known, cardiac dilation and heart failure may develop during the last month of pregnancy or the first few months after birth. The condition may result from a pre existing cardiomyopathy not apparent prior to pregnancy.  Option B: Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an unknown etiology but a strong familial tendency.  Option C: Myocarditis isn’t specifically associated with childbirth. Myocarditis is an inflammation of the heart muscle (myocardium). Myocarditis can affect the heart muscle and the heart’s electrical system, reducing the heart’s ability to pump and causing rapid or abnormal heart rhythms (arrhythmias).  Option D: Restrictive cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial. Restrictive cardiomyopathy (RCM) is a rare disease of the myocardium and is the least common of the three clinically recognized and described cardiomyopathies. It is characterized by diastolic dysfunction with restrictive ventricular physiology, whereas systolic function often remains normal. Atrial enlargement occurs due to impaired ventricular filling during diastole, but the volume and wall thickness of the ventricles are usually normal. NCLEXRN-03-069 Question Tag: cardiomyopathy Question Category: Physiological Integrity, Physiological Adaptation NCLEXRN-03-071 Question Tag: heart muscle Question Category: Physiological Integrity, Physiological Adaptation What is the term used to describe an enlargement of the heart muscle?  A. Cardiomegaly  B. Cardiomyopathy  C. Myocarditis  D. Pericarditis Correct Answer: A. Cardiomegaly Cardiomegaly denotes an enlarged heart muscle. The most critical pathophysiological changes leading to cardiomegaly include dilated hypertrophy, fibrosis, and contractile malfunction. Contractile dysfunction and abnormal myocardial remodeling can lead to hypertrophic cardiomyopathy or dilated cardiomyopathy. Mechanical stretching, circulating neurohormones and oxidative stress are significant stimuli for the signal transduction of inflammatory cytokines and MAP kinase in cardiomyocytes. Signal transduction leads to changes in structural proteins and proteins that regulate excitation-contraction. Dilated cardiomyopathy mutations result in a reduced force of the sarcomere contraction and a reduction in sarcomere content. Hypertrophic cardiomyopathy mutations result in a molecular phenotype of hyperdynamic contractility, poor relaxation, and increased energy consumption.  Option B: Cardiomyopathy is a heart muscle disease of unknown origin. In cardiomyopathy, the heart muscle becomes enlarged, thick, or rigid. In rare cases, the muscle tissue in the heart is replaced with scar tissue.  Option C: Myocarditis refers to inflammation of heart muscle. It is an inflammatory disease of the myocardium with a wide range of clinical presentations, from subtle to devastating.  Option D: Pericarditis is an inflammation of the pericardium. Pericarditis is usually acute – it develops suddenly and may last up to several months. The condition usually clears up after 3 months, but sometimes attacks can come and go for years. When a client has pericarditis, the membrane around the heart is red and swollen, like the skin around a cut that becomes inflamed. Sometimes there is extra fluid in the space between the pericardial layers, which is called pericardial effusion. NCLEXRN-03-072 Question Tag: heart failure Question Category: Physiological Integrity, Physiological Adaptation Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following conditions?  A. Pericarditis  B. Hypertension  C. Obliterative  D. Restrictive Correct Answer: D. Restrictive These are the classic symptoms of heart failure. Heart failure is the pathophysiologic state in which the heart, via an abnormality of cardiac function (detectable or not), fails to pump blood at a rate commensurate with the requirements of the metabolizing tissues or is able to do so only with an elevated diastolic filling pressure.  Option A: Pericarditis is exhibited by a feeling of fullness in the chest and auscultation of a pericardial friction rub.  Option B: Hypertension is usually exhibited by headaches, visual disturbances, and a flushed face. Myocardial infarction causes heart failure but isn’t related to these symptoms.  Option C: Obliterative cardiomyopathy is very rare. It may result from the end stage of eosinophilic syndromes, in which intracavitary thrombus fills the left ventricular apex and hampers the filling of the ventricles. NCLEXRN-03-073 Question Tag: cardiomyopathy Question Category: Physiological Integrity, Physiological Adaptation Which of the following types of cardiomyopathy does not affect cardiac output?  A. Dilated  B. Hypertrophic  C. Restrictive  D. Obliterative Correct Answer: B. Hypertrophic Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively unchanged. Three explanations for the systolic anterior motion of the mitral valve have been offered, as follows: (1) the mitral valve is pulled against the septum by contraction of the papillary muscles, which occurs because of the valve’s abnormal location and septal hypertrophy altering the orientation of the papillary muscles; (2) the mitral valve is pushed against the septum because of its abnormal position in the outflow tract; (3) the mitral valve is drawn toward the septum because of the lower pressure that occurs as blood is ejected at high velocity through a narrowed outflow tract (Venturi effect).  Option A: Dilated cardiomyopathy causes a decrease in cardiac output. Progressive dilation can lead to significant mitral and tricuspid regurgitation, which may further diminish the cardiac output and increase end-systolic volumes and ventricular wall stress. In turn, this leads to further dilation and myocardial dysfunction.  Option C: Restrictive cardiomyopathy causes decreased cardiac output. Reduced LV filling leads to reduced stroke volume resulting in low cardiac output symptoms such as fatigue and lethargy. Increased filling pressures cause pulmonary and systemic congestion and symptomatic dyspnea.  Option D: Obliterative cardiomyopathy may affect cardiac output because a thrombus hampers ventricular filling, which may decrease the cardiac output.