Fabulous Test Bank Questions

Question 1

Cheyne-Stokes respirations are described as a:
a) Sustained deep rapid but regular pattern of breathing
b) Crescendo-decrescendo pattern of breathing, followed by a period of apnea
c) Prolonged inspiratory period, gradually followed by a short expiratory period
d) Completely irregular breathing pattern with random shallow, deep breaths and irregular pauses

Answer 1

B
Cheyne-Stokes respiration is an abnormal rhythm of breathing (periodic breathing) that alternates between hyperventilation and apnea.

Question 2

What characteristic is a medical criterion of brain death?
a) Akinetic mutism
b) Coma
c) Apnea
d) Locked-in syndrome

Answer 2

C
Apnea is viewed as a criterion of brainstem death, whereas the remaining options reflect cerebral death.

Question 3

A sudden, explosive, disorderly discharge of cerebral neurons is termed:
a) Reflex
b) Seizure
c) Epilepsy
d) Convulsion

Answer 3

B
The description describes a seizure.

Question 4

A complex partial seizure is described as:
a) Alternating of tonic and clonic movements
b) Impairment of both consciousness and the ability to react to exogenous stimuli
c) Focal motor movement without loss of consciousness
d) One seizure followed by another in less than 1 minute

Answer 4

B
A complex partial seizure results in impaired consciousness, as well as the inability to respond to exogenous stimuli.

Question 5

The most critical aspect in correctly diagnosing a seizure disorder and establishing its cause is:
a) Computed tomographic (CT) scan
b) Cerebrospinal fluid analysis
c) Skull x-ray studies
d) Health history

Answer 5

D
Although the history may be supplemented with the remaining options, it remains the pivotal tool for establishing the cause of a seizure disorder.

Question 6

What type of seizure starts in the fingers and progressively spreads up the arm and extends to the leg?
a) Complex-psychomotor seizure
b) Focal (partial) Jacksonian seizure
c) Generalized seizures
d) Atonic-drop seizure

Answer 6

B
Focal (partial) Jacksonian seizures most often begin in the face and fingers and then progressively spread to other body parts.

Question 7

What is the normal intracranial pressure (in mm Hg)?
a) 5 - 15
b) 7 - 20
c) 12 - 14
d) 80 - 120

Answer 7

A
Intracranial pressure is normally 5 to 15 mm Hg or 60 to 180 cm water (H2O). The remaining options reflect increased intracranial pressure.

Question 8

Cerebral edema is an increase in the fluid content of the brain’s:
a) Ventricles
b) Tissue
c) Neurons
d) Meninges

Answer 8

B
Cerebral edema is an increase in the fluid content of the brain tissue; that is, a net accumulation of water within the brain.

Question 9

The body compensates for a rise in intracranial pressure by first displacing the:
a) Cerebrospinal fluid
b) Arterial blood
c) Venous blood
d) Cerebral cells

Answer 9

A
A rise in intracranial pressure necessitates an equal reduction in the volume of the other contents. The most readily displaced content of the cranial vault is cerebrospinal fluid.

Question 10

Stage 1 intracranial hypertension is caused by the:
a) Loss of autoregulation that normally maintains constant blood flow during changes in cerebral perfusion pressure
b) Displacement of cerebrospinal fluid, followed by compression of the cerebral venous system
c) Vasoconstriction of the cerebral arterial system with reciprocal increase in systemic blood pressure
d) Compression of the medulla oblongata in the brainstem by herniation of the cerebral cortex

Answer 10

B
If intracranial pressure remains high after cerebrospinal fluid (CSF) displacement out of the cranial vault, then cerebral blood volume is altered, resulting in stage 1 intracranial hypertension. Vasoconstriction and external compression of the venous system occur in an attempt to further decrease the intracranial pressure. None of the remaining options accurately describe the cause of stage 1 intracranial hypertension.

Question 11

Dilated and sluggish pupils, widening pulse pressure, and bradycardia are clinical findings evident of which stage of intracranial hypertension?
a) 1
b) 2
c) 3
d) 4

Answer 11

C
Stage 3 intracranial hypertension exhibits clinical manifestations that include decreasing levels of arousal, Cheyne-Stokes respiration or central neurogenic hyperventilation, pupils that become sluggish and constricted, widened pulse pressure, and bradycardia. These responses are not characteristic of any other stage.

Question 12

Which characteristic is the most critical index of nervous system dysfunction?
a. Size and reactivity of pupils
b. Pattern of breathing
c. Motor response
d. Level of consciousness

Answer 12

ANS: D
Level of consciousness is the most critical clinical index of nervous system function or dysfunction. An alteration in consciousness indicates either improvement or deterioration
of a person’s condition. No other option is used as the critical index of the nervous system.

Question 13

Diagnostic criteria for a persistent vegetative state include:
a. Absence of eye opening
b. Lack of subcortical responses to pain stimuli
c. Roving eye movements with visual tracking
d. Return of autonomic functions such as gastrointestinal function

Answer 13

ANS: D
Diagnostic criteria for vegetative state (VS) include the return of professed vegetative (autonomic) functions, including sleep-wake cycles and normalization of respiratory and digestive system functions. Only the correct option appropriately describes the diagnostic criteria for a VS.

Question 14

Uncal herniation occurs when:
a. The hippocampal gyrus shifts from the middle fossa through the tentorial notch into the posterior fossa.
b. The diencephalon shifts from the middle fossa straight downward through the tentorial notch into the posterior fossa.
c. The cingulate gyrus shifts under the falx cerebri.
d. A cerebellar tonsil shifts through the foramen magnum

Answer 14

ANS: A
Uncal herniation (i.e., hippocampal herniation, lateral mass herniation) occurs when the uncus or hippocampal gyrus (or both) shifts from the middle fossa through the tentorial notch into the posterior fossa. This shift results in the compression of the ipsilateral third cranial nerve (CN), impairing parasympathetic function. This impairment is carried on in the periphery of the nerve, then in the contralateral third CN, and finally in the mesencephalon, inducing coma. The other options do not appropriately describe when uncal herniation occurs.

Question 15

Diffuse axonal injuries (DAIs) of the brain often result in:
a. Reduced levels of consciousness
b. Mild but permanent dysfunction
c. Fine motor tremors
d. Visual disturbances

Answer 15

ANS: A
Focal brain injuries account for more than two-thirds of head injury deaths; DAIs accounts for less than one third. However, more severely disabled survivors, including those in an unresponsive state or reduced level of consciousness, have DAIs. The other options do not appropriately complete the stem.

Question 16

What event is most likely to occur to the brain in a classic cerebral concussion?
a. Brief period of vital sign instability
b. Cerebral edema throughout the cerebral cortex
c. Cerebral edema throughout the diencephalon
d. Disruption of axons extending from the diencephalon and brainstem

Answer 16

ANS: A
Transient cessation of respiration can occur with brief periods of bradycardia, and a decrease in blood pressure occurs, lasting 30 seconds or less. Vital signs stabilize within a few seconds to within normal limits. The other options do not accurately describe an event associated with a classic cerebral concussion

Question 17

Which disorder has clinical manifestations that include decreased consciousness for up to 6 hours, as well as retrograde and posttraumatic amnesia?
a. Mild concussion
b. Classic concussion
c. Cortical contusion
d. Acute subdural hematoma

Answer 17

ANS: B
Evidence of a classic concussion is the immediate loss of consciousness, which lasts less than 6 hours. Retrograde and anterograde (posttraumatic) amnesia is also present. The other options do not apply.

Question 18

Oxygenated blood flows through which vessel?
a. Superior vena cava
b. Pulmonary veins
c. Pulmonary artery
d. Coronary veins

Answer 18

ANS: B
Only the four pulmonary veins, two from the right lung and two from the left lung, carry oxygenated blood from the lungs to the left side of the heart.

Question 19

In the normal electrocardiogram, what does the PR interval represent?
a. Atrial depolarization
b. Ventricular depolarization
c. Atrial activation to onset of ventricular activity
d. Electrical systole of the ventricles

Answer 19

ANS: C
The PR interval is a measure of time from the onset of atrial activation to the onset of ventricular activation; it normally ranges from 0.12 to 0.20 seconds. The PR interval represents the time necessary to travel from the sinus node through the atrium, the atrioventricular (AV) node, and the His–Purkinje system to activate ventricular myocardial cells. This selection is the only option that accurately describes the PR interval.

Question 20

The cardiac electrical impulse normally begins spontaneously in the sinoatrial (SA) node because it:
a. Has a superior location in the right atrium.
b. Is the only area of the heart capable of spontaneous depolarization.
c. Has rich sympathetic innervation via the vagus nerve.
d. Depolarizes more rapidly than other automatic cells of the heart.

Answer 20

ANS: D
The electrical impulse normally begins in the SA node because its cells depolarize more rapidly than other automatic cells. This selection is the only option that accurately explains why cardiac electrical impulses normally begin spontaneously in the SA node.

Ref: pg 1095 McCance

Question 21

What period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated?
a. Refractory
b. Hyperpolarization
c. Threshold
d. Sinoatrial (SA)

Answer 21

ANS: A
During the refractory period, no new cardiac action potential can be initiated by a stimulus. This selection is the only option that accurately identifies the period described in the question.

Ref: pg 1095 McCance

Question 22

Which complex (wave) represents the sum of all ventricular muscle cell depolarizations?
a. PRS
b. QRS
c. QT interval
d. P

Answer 22

ANS: B
Only the QRS complex represents the sum of all ventricular muscle cell depolarizations.

Ref: pg 1095 McCance

Question 23

If the sinoatrial (SA) node fails, then at what rate (depolarizations per minute) can the atrioventricular (AV) node depolarize?
a. 60 to 70
b. 40 to 60
c. 30 to 40
d. 10 to 20

Answer 23

ANS: B
If the SA node is damaged, then the AV node will become the heart’s pacemaker at a rate of approximately 40 to 60 spontaneous depolarizations per minute.

Ref: pg 1095 McCance

Question 24

Continuous increases in left ventricular filling pressures result in which disorder?
a. Mitral regurgitation
b. Mitral stenosis
c. Pulmonary edema
d. Jugular vein distention

Answer 24

ANS: C
Pressure changes are important because increased left ventricular filling pressures back up into the pulmonary circulation, where they force plasma out through vessel walls, causing fluid to accumulate in lung tissues (pulmonary edema). This selection is the only option that accurately identifies the disorder described in the question

Question 25

Where is the major cardiovascular center in the central nervous system?
a. Frontal lobe
b. Thalamus
c. Brainstem
d. Hypothalamus

Answer 25

ANS: C
The major cardiovascular control center is in the brainstem in the medulla with secondary areas in the hypothalamus, the cerebral cortex, the thalamus, and the complex networks of exciting or inhibiting interneurons (connecting neurons) throughout the brain. This selection is the only option that accurately identifies the cardiovascular control center.

Ref: pg 1104 McCance

Question 26

probs not on test?
What is the major effect of a calcium channel blocker such as verapamil on cardiac contractions?
a. Increases the rate of cardiac contractions.
b. Decreases the strength of cardiac contractions.
c. Stabilizes the rhythm of cardiac contractions.
d. Stabilizes the vasodilation during cardiac contractions.

Answer 26

B
The L-type, or long-lasting, channels are the predominant type of calcium channels and are the channels blocked by calcium channel–blocking drugs (verapamil, nifedipine, diltiazem). The major effect of these medications is to decrease the strength of cardiac contraction. This selection is the only option that accurately identifies the effect of a calcium channel blocker on the cardiac contractions

Question 27

not on test?
Which factor is responsible for the hypertrophy of the myocardium associated with hypertension?
a. Increased norepinephrine
b. Adducin
c. Angiotensin II
d. Insulin resistance

Answer 27

C
Of the available options, only angiotensin II is responsible for the hypertrophy of the myocardium and much of the renal damage associated with hypertension.

Question 28

not on test?
Which statement best describes Raynaud disease?
a. Inflammatory disorder of small- and medium-size arteries in the feet and sometimes in the hands
b. Neoplastic disorder of the lining of the arteries and veins of the upper extremities
c. Vasospastic disorder of the small arteries and arterioles of the fingers and, less commonly, of the toes
d. Autoimmune disorder of the large arteries and veins of the upper and lower extremities

Answer 28

C
Attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, of the toes characterize Raynaud phenomenon and Raynaud disease and is the only option that accurately describes this disease

Question 29

What is the expected electrocardiogram (ECG) pattern when a thrombus in a coronary artery permanently lodges in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium?
a. Prolonged QT interval
b. ST elevation myocardial infarction (STEMI)
c. ST depression myocardial infarction (STDMI)
d. Non-ST elevation myocardial infarction (non-STEMI)

Answer 29

B
Individuals with this pattern on an ECG usually have significant elevations in the ST segments and are categorized as having STEMI. The other options are not associated with the described pathologic condition

Question 30

How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)?
a. By increasing the peripheral vasoconstriction
b. By causing dysrhythmias as a result of hyperkalemia
c. By reducing the contractility of the myocardium
d. By stimulating the sympathetic nervous system

Answer 30

A
Angiotensin II is released during myocardial ischemia and contributes to the pathogenesis of a myocardial infarction (MI) in several ways. First, it results in the systemic effects of peripheral vasoconstriction and fluid retention. These homeostatic responses are counterproductive in that they increase myocardial work and thus exacerbate the effects of the loss of myocyte contractility. Angiotensin II is also locally released, where it is a growth factor for vascular smooth muscle cells, myocytes, and cardiac fibroblasts; promotes catecholamine release; and causes coronary artery spasm. This selection is the only option that accurately describes how angiotensin II increases workload after a MI.

Question 31

The pulsus paradoxus that occurs as a result of pericardial effusion is caused by a dysfunction in which mechanism?
a. Diastolic filling pressures of the right ventricle and reduction of blood volume in both ventricles
b. Blood ejected from the right atrium and reduction of blood volume in the right ventricle
c. Blood ejected from the left atrium and reduction of blood volume in the left ventricle
d. Diastolic filling pressures of the left ventricle and reduction of blood volume in all four heart chambers.

Answer 31

D
Pulsus paradoxus means that the arterial blood pressure during expiration exceeds arterial pressure during inspiration by more than 10 mm Hg. This clinical finding reflects impairment of diastolic filling of the left ventricle plus a reduction of blood volume within all four cardiac chambers. This selection is the only option that accurately describes the mechanism.

Question 32

A patient reports sudden onset of severe chest pain that radiates to the back and worsens with respiratory movement and when lying down. These clinical manifestations describe:
a. Myocardial infarction (MI)
b. Pericardial effusion
c. Restrictive pericarditis
d. Acute pericarditis

Answer 32

D
Most individuals with acute pericarditis describe several days of fever, myalgias, and malaise, followed by the sudden onset of severe chest pain that worsens with respiratory movements and with lying down. Although the pain may radiate to the back, it is generally felt in the anterior chest and may be initially confused with the pain of an acute MI. Individuals with acute pericarditis also may report dysphagia, restlessness, irritability, anxiety, and weakness. This selection is the only option with these symptoms.

Question 33

:)
Ventricular dilation and grossly impaired systolic function, leading to dilated heart failure, characterize which form of cardiomyopathy?
a. Congestive (Dilated)
b. Hypertrophic
c. Septal
d. Dystrophic

Answer 33

A
Only dilated cardiomyopathy (congestive cardiomyopathy) is characterized by ventricular dilation and grossly impaired systolic function, leading to dilated heart failure.

Question 34

:)
A disproportionate thickening of the interventricular septum is the hallmark of which form of cardiomyopathy?
a. Dystrophic
c. Restrictive
b. Hypertrophic
d. Dilated

Answer 34

B
Only hypertrophic cardiomyopathy is characterized by a thickening of the septal wall, which may cause outflow obstruction to the left ventricle outflow tract

Question 35

:)
Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of cardiomyopathy?
a. Infiltrative
b. Restrictive
c. Septal
d. Hypertrophic

Answer 35

B
Restrictive cardiomyopathy may occur idiopathically or as a cardiac manifestation of systemic diseases, such as scleroderma, amyloidosis, sarcoidosis, lymphoma, and hemochromatosis, or a number of inherited storage diseases. This characterization is not true of the other forms of cardiomyopathy.

Question 36

:)
Which condition is a cause of acquired aortic regurgitation?
a. Congenital malformation
b. Cardiac failure
c. Rheumatic fever
d. Coronary artery disease (CAD)

Answer 36

C
Rheumatic heart disease, bacterial endocarditis, syphilis, hypertension, connective tissue disorders (e.g., Marfan syndrome, ankylosing spondylitis), appetite suppressing medications, trauma, or atherosclerosis can cause acquired aortic regurgitation. This selection is the only available option that is known to cause acquired aortic regurgitation.

ref: McCance 1169

Question 37

Which predominantly female valvular disorder is thought to have an autosomal dominant inheritance pattern, as well as being associated with connective tissue disease?
a. Mitral valve prolapse
b. Tricuspid stenosis
c. Tricuspid valve prolapse
d. Aortic insufficiency

Answer 37

A
Mitral valve prolapse tends to be most prevalent in young women. Studies suggest an autosomal dominant and X-linked inheritance pattern. Because mitral valve prolapse often is associated with other inherited connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta), it is thought to result from a genetic or environmental disruption of valvular development during the fifth or sixth week of gestation. This provided history is not associated with any of the other options.

REF: McCance 1170

Question 38

Which disorder causes a transitory truncal rash that is nonpruritic and pink with erythematous macules that may fade in the center, making them appear as a ringworm?
a. Fat emboli
b. Rheumatic fever
c. Bacterial endocarditis
d. Myocarditis of acquired immunodeficiency syndrome

Answer 38

B
Erythema marginatum is a distinctive truncal rash that often accompanies acute rheumatic fever. It consists of nonpruritic, pink erythematous macules that never occur on the face or hands. This presentation is not associated with any of the other options.

Question 39

What is the most common cardiac disorder associated with acquired immunodeficiency syndrome (AIDS) a. Cardiomyopathy
b. Myocarditis
c. Left heart failure
d. Heart block

Answer 39

C
Pericardial effusion and left heart failure are the most common complications of human immunodeficiency virus (HIV) infection. Other conditions include cardiomyopathy, myocarditis, tuberculous pericarditis, infective and nonbacterial endocarditis, heart block, pulmonary hypertension, and nonantiretroviral drug-related cardiotoxicity.

Question 40

A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which form of heart failure may result from pulmonary disease and elevated pulmonary vascular resistance?
a. Right heart failure
b. Left heart failure
c. Low-output failure
d. High-output failure

Answer 40

A
Right heart failure is defined as the inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal central venous pressure. This condition is often a result of pulmonary disease and the resulting elevated pulmonary vascular resistance.

Question 41

What cardiac pathologic condition contributes to ventricular remodeling?
a. Left ventricular hypertrophy
b. Right ventricular failure
c. Myocardial ischemia
d. Contractile dysfunction

Answer 41

C
Of the options available, myocardial ischemia contributes to inflammatory, immune, and neurohumoral changes that mediate a process called ventricular remodelling.

Question 42

:)
Which assessment findings are clinical manifestations of aortic stenosis? (Select all that apply.)
a. Jugular vein distention
b. Bounding pulses
c. Hypotension
d. Angina
e. Syncope

Answer 42

D, E
The classic manifestations of aortic stenosis are angina, syncope, and heart failure. None of the other options are associated with aortic stenosis.

REF: 1168-1169 McCance

Question 43

Which risk factors are associated with infective endocarditis? (Select all that apply.)
a. Rheumatic fever
b. Intravenous drug use
c. Long-term indwelling catheterization
d. Aortic regurgitation
e. Heart valve disease

Answer 43

B, C, E
Risk factors for infective endocarditis include acquired valvular heart disease, intravenous drug abuse, long-term indwelling catheterization (e.g., for pressure monitoring, hyperalimentation, or hemodialysis), and recent cardiac surgery. Neither rheumatic fever nor aortic regurgitation is considered a risk factor for infective endocarditis.

Question 44

:)
Match the descriptions with the corresponding terms:
______A. Impairs flow from left atrium to left ventricle
______B. Impairs flow from the left ventricle
______C. Backflow into left atrium
______D. Backflow into right atrium
______E. Backflow into left ventricle

49. Aortic stenosis
50. Aortic regurgitation
51. Mitral stenosis
52. Tricuspid regurgitation
53. Mitral regurgitation

Answer 44

A = 51 (Mitral stenosis)
- Mitral stenosis impairs the flow of blood from the left atrium to the left ventricle

B = 49 (Aortic stenosis)
- Outflow obstruction increases pressure within the left ventricle as it tries to eject blood through the narrowed opening. Left ventricular hypertrophy develops to compensate for the increased workload.

C = 53 (Mitral regurgitation)
- Mitral regurgitation permits the backflow of blood from the left ventricle into the left atrium during ventricular systole, giving rise to a loud pansystolic (throughout systole) murmur heard best at the apex that radiates into the back and axillae.

D = 52 (Tricuspid regurgitation)
- Tricuspid regurgitation is more common than tricuspid stenosis and is usually associated with cardiac failure and dilation of the right ventricle, secondary to pulmonary hypertension.

E = 50 (Aortic regurgitation)
- During systole, blood is ejected from the left ventricle into the aorta. If the aortic semilunar valve fails to close completely, then some of the ejected blood flows back into the left ventricle during diastole.

REF: 1168-1170 McCance

Question 45

The nurse is assessing a patient with left-sided heart failure. Which symptom would the nurse expect to find?

a. Dependent edema
b. Distended neck veins
c. Dyspnea and crackles
d. Nausea and vomiting

Answer 45

c. Dyspnea and crackles

Rationale:
In left-sided heart failure, signs and symptoms are related to pulmonary congestion. Dependent edema and distended neck veins are related to right-sided heart failure.

Question 46

A patient is admitted with an acute myocardial infarction (AMI). The nurse knows that an angiotensin-converting enzymes (ACE) inhibitor should be started within 24 hours to reduce the incidence of which process?

a. Myocardial stunning
b. Hibernating myocardium
c. Myocardial remodeling
d. Tachycardia

Answer 46

c. Myocardial remodeling

Rationale:
Myocardial remodeling is a process mediated by angiotensin II, aldosterone, catecholamine, adenosine, and inflammatory cytokines, which causes myocyte hypertrophy and loss of contractile function in the areas of the heart distant from the site of infarctions. ACE inhibitors reduce the incidence of remodeling.