Question 1

A nurse is assessing a child with transposition of the great arteries. Which associated defect should the nurse expect to see in this client?

Accepted Answer

Answer reason: An interatrial communication (such as a patent foramen ovale, often functionally similar to an ASD) is a common associated lesion that permits this mixing and partially improves oxygenation. Without a mixing lesion (PFO/ASD, VSD, or PDA), profound cyanosis occurs early because oxygenated blood recirculates to the lungs and deoxygenated blood recirculates to the body. Other options listed are more characteristic of different congenital syndromes (e.g., hypoplastic left heart with mitral atresia/left ventricular hypoplasia), rather than being the expected associated defect in isolated TGA.

Question 2

Which finding is seen during cardiac catheterization of a child with pulmonic stenosis?

Accepted Answer

Answer reason: This hemodynamic pattern explains cyanosis in critical pulmonic stenosis when right-sided pressures exceed left-sided pressures. Left-to-right shunting would require higher left-sided pressures, which is not the typical consequence of an isolated outflow obstruction on the right. Rather than decreased right-sided pressure, catheterization generally shows elevated right ventricular systolic pressure and a pressure gradient across the pulmonic valve, and it would not cause increased oxygenation in the left heart.

Question 3

Heart failure post myocardial infarction is most commonly caused by?

Accepted Answer

Answer reason: Myocardial infarction causes ischemic necrosis of cardiac muscle, reducing the number of functioning myocytes available to generate force. This leads to decreased left ventricular systolic performance and reduced ejection fraction, which is the most direct and common pathway to post-MI heart failure. The resulting fall in cardiac output triggers neurohormonal compensation (SNS/RAAS) that can worsen fluid retention and remodeling, further exacerbating failure. Increased workload and oxygen demand are contributors to ischemia and decompensation but are not the primary immediate mechanism of heart failure after an infarct. Ventricular hypertrophy is typically a chronic adaptation (e.g., long-standing hypertension) rather than the usual initial cause of post-MI heart failure.

Question 4

A client has a continuous blood pressure reading of 142/90 mm Hg. The reading is interpreted as indicative of what?

Accepted Answer

Answer reason: A reading of 142/90 mm Hg meets Stage 1 criteria because systolic 140–159 and/or diastolic 90–99 falls in that range. It is not normal or prehypertension because both systolic and diastolic exceed those cutoffs. It is not Stage 2 because Stage 2 generally requires systolic ≥160 or diastolic ≥100, which are not present here. Persistent values in this range warrant confirmation with repeat measurements and cardiovascular risk assessment.

Question 5

Which condition causes heart failure after a myocardial infarction (MI)?

Accepted Answer

Answer reason: Infarcted tissue becomes noncontractile, and even surrounding stunned/ischemic myocardium may contribute to transient or persistent ventricular dysfunction. This impaired contractility increases end-systolic volume and ventricular filling pressures, leading to pulmonary congestion and other heart failure manifestations. Increased workload or oxygen demand can worsen ischemia, but they are not the primary mechanism causing post-MI heart failure. Diastolic filling problems can occur in some settings, but the classic post-MI failure mechanism is systolic dysfunction due to damaged myocardium.

Question 6

A client’s electrocardiogram shows ST elevation in leads II, III, and aVF, suggesting occlusion of the right coronary artery. The client asks the nurse what area of the heart this has affected. What is the nurse’s best response?

Accepted Answer

Answer reason: Leads II, III, and aVF are the classic “inferior leads,” reflecting the inferior wall of the left ventricle. This pattern commonly corresponds to right coronary artery occlusion (or less commonly the left circumflex depending on dominance). By contrast, anterior wall involvement is suggested by V1–V4, and lateral wall involvement by I, aVL, V5–V6.

Question 7

A client with abdominal aortic aneurysm asks the nurse in which area are abdominal aortic aneurysms most commonly located. The best response by the nurse is?

Accepted Answer

Answer reason: Most abdominal aortic aneurysms are infrarenal because the segment below the renal arteries is exposed to high atherosclerotic burden and has relatively less supportive medial elastin, predisposing to dilation. This location is classically described as between the renal arteries and the aortic bifurcation. Aneurysms “adjacent to the aortic arch” describe thoracic aneurysms, not abdominal ones. “Proximal to the renal arteries” corresponds to suprarenal aneurysms, which are less common and have different operative considerations due to renal perfusion risk.

Question 8

A client who was recently diagnosed with an aneurysm asks the nurse if any genetic disease is closely linked to an aneurysm. What is the best response by the nurse?

Accepted Answer

Answer reason: Marfan syndrome (fibrillin-1 defect) classically causes aortic root dilation and thoracic aortic aneurysm, making it the strongest genetic association among the choices. Hemophilia primarily causes bleeding due to clotting factor deficiency rather than structural vessel wall weakness. Cystic fibrosis and sickle cell anemia have other major complications but are not closely linked to aneurysm formation in the way Marfan syndrome is.

Question 9

The nurse is reviewing a client’s echocardiogram report, which states, “hypertrophy of the ventricular septum.” The client should be further evaluated for which type of cardiomyopathy?

Accepted Answer

Answer reason: This pattern aligns with the obstructive form, where systolic anterior motion of the mitral valve and dynamic outflow obstruction may occur. In contrast, dilated cardiomyopathy is characterized by ventricular chamber enlargement and reduced systolic function rather than septal thickening, and restrictive cardiomyopathy is primarily a diastolic filling disorder with relatively normal ventricular wall thickness. Therefore, the septal hypertrophy finding most directly indicates evaluation for obstructive hypertrophic disease.

Question 10

The nurse is teaching a client about blood pressure and hormones. Which of the following responses indicates the client understands which hormone raises arterial pressure and promotes venous return?

Accepted Answer

Answer reason: It also supports venous return by increasing venous tone (venoconstriction), which boosts preload. In addition, it stimulates aldosterone and ADH release and promotes thirst, increasing intravascular volume and further supporting blood pressure and venous return. Angiotensin I is relatively inactive until converted by ACE, making it a weaker choice for the described direct hemodynamic effects.

Question 11

The nurse knows that a 45-year-old client with severe hypertension will experience increased workload of the heart due to which of the following?

Accepted Answer

Answer reason: This elevated arterial resistance raises ventricular wall stress during systole, increasing myocardial oxygen demand and overall cardiac work. Over time, this mechanism drives compensatory left ventricular hypertrophy and can contribute to heart failure. Increased preload refers to higher end-diastolic volume/venous return and is more directly linked to volume overload states rather than primary pressure overload from hypertension. “Overload of the heart” is nonspecific and does not identify the key hemodynamic determinant.

Question 12

The nurse evaluates her teaching by asking the student nurse which term is used to describe the amount of stretch on the myocardium at the end of diastole. Which is the most accurate response?

Accepted Answer

Answer reason: This concept reflects the Frank–Starling mechanism, where greater filling generally increases stroke volume up to a physiologic limit. Afterload is different because it represents the resistance/pressure the ventricle must overcome during systole (e.g., systemic vascular resistance/aortic pressure). Cardiac output and cardiac index are performance measures (flow per minute and normalized to body surface area) rather than a description of end-diastolic stretch.

Question 13

Which statement by the nurse best describes a characteristic of valvular pulmonic stenosis?

Accepted Answer

Answer reason: ” Valvular pulmonic stenosis is most commonly caused by congenital fusion of the pulmonary valve commissures, producing a narrowed valve orifice and obstructing right ventricular outflow. This obstruction increases right ventricular afterload, leading to right ventricular hypertrophy rather than left-sided hypertrophy. A “normal” valve would not explain the stenosis, and a hypoplastic right ventricle is more characteristic of severe underdevelopment conditions rather than isolated valvular stenosis. Therefore, the description that best matches the typical anatomy is fusion between valve cusps.

Question 14

Which of the following are required to establish a diagnosis of acute rheumatic fever?

Accepted Answer

Answer reason: The Jones criteria provide the standardized major/minor manifestations used to make the diagnosis, but they must be paired with proof of recent GAS exposure (e.g., elevated ASO/anti-DNase B or positive throat culture). Fever alone and an arbitrary number of Jones criteria is not the requirement; rather, specific combinations of major/minor criteria are used. Staphylococcal blood cultures point toward bacteremia/endocarditis, not rheumatic fever, and nonspecific “laboratory tests” are supportive but not sufficient without GAS evidence and Jones criteria.

Question 15

In order to anticipate problems in a client following a myocardial infarction (MI), the nurse should understand that which type of physiological changes will increase serum glucose levels and free fatty acid production?

Accepted Answer

Answer reason: These hormones increase hepatic glycogenolysis and gluconeogenesis, raising serum glucose, and they stimulate lipolysis in adipose tissue, increasing circulating free fatty acids. This pattern is fundamentally a change in energy handling and fuel mobilization, which defines a metabolic response. Electrophysiological, hematological, and mechanical changes describe rhythm/conduction, clotting/blood components, and pump/structure effects, respectively, and do not directly account for stress hyperglycemia with increased free fatty acids.

Question 16

A client’s electrocardiogram (ECG) is showing ST elevation in leads V2,V3, and V4. Which artery is most likely to be occluded?

Accepted Answer

Answer reason: Leads V2–V4 view the anterior wall (anteroseptal region) of the left ventricle, which is primarily supplied by the left anterior descending (LAD) coronary artery. An LAD occlusion therefore most directly explains anterior precordial ST elevation. By contrast, right coronary artery occlusion more often produces inferior changes (II, III, aVF), while circumflex involvement commonly affects lateral leads (I, aVL, V5–V6).

Question 17

While assessing a client diagnosed with angina, the client asks what causes it. Which of the following responses by the nurse would be the most appropriate?

Accepted Answer

Answer reason: This is most commonly from reduced coronary blood flow related to atherosclerotic narrowing, leading to insufficient oxygen delivery during increased demand (e.g., exertion, stress). This explanation captures the overarching mechanism of all angina types, including stable and vasospastic forms. Coronary artery spasm can cause angina (variant/Prinzmetal), but it is a specific etiology rather than the most general cause being asked for. Changes in preload or afterload may influence myocardial oxygen demand, but they are not the primary causal definition of angina.

Question 18

Which physiological change would indicate that the baroreceptors in the carotid artery walls and aorta are functioning?

Accepted Answer

Answer reason: When blood pressure rises, increased stretch increases baroreceptor firing and triggers autonomic reflexes to lower sympathetic tone and increase vagal tone, stabilizing pressure. Oxygen and carbon dioxide tensions are primarily sensed by peripheral and central chemoreceptors, not baroreceptors. Heart rate can change as part of the baroreflex response, but it is a downstream effect rather than the primary variable being detected by the receptors.

Question 19

Which of the following parameters increases as myocardial oxygen consumption increases?

Accepted Answer

Answer reason: Increases in preload and afterload raise ventricular wall stress (Laplace relationship), which directly increases oxygen demand. Higher contractility and a faster heart rate both increase ATP use and shorten diastole, increasing demand while potentially reducing coronary perfusion time. Cerebral and renal blood flow are not primary determinants of MVO2 and do not reliably increase in parallel with myocardial oxygen demand.

Question 20

A nurse is performing a cardiac assessment on a child. Which characteristic would indicate a diagnosis of a grade 1 heart murmur?

Accepted Answer

Answer reason: Heart murmur grading reflects intensity, with grade 1 being very faint and often difficult to hear. A grade 1 murmur is typically softer than normal S1/S2 and may only be audible under optimal conditions with careful auscultation. Louder findings such as being equal to heart sounds suggest a higher grade, while a palpable thrill is characteristic of grade 4 or greater. Being audible without a stethoscope indicates a very high-grade murmur (grade 6).

Question 21

A client with Down syndrome (trisomy 21) comes to the pediatric clinic for a well visit. Which cardiac anomaly would this child be at risk for?

Accepted Answer

Answer reason: This lesion often produces a large left-to-right shunt and early congestive heart failure if unrepaired, making it a classic high-yield association for trisomy 21. While isolated ASD or VSD can also occur, the combined AV septal defect is the most characteristic congenital heart disease linked with Down syndrome. Pulmonic stenosis is more classically associated with other genetic syndromes (e.g., Noonan) rather than trisomy 21.

Question 22

A nurse is reviewing the waveforms of an electrocardiogram of an infant with a nursing student. The student asks the nurse which waveform indicates ventricular depolarization and contraction. What would be the best response by the nurse?

Accepted Answer

Answer reason: The P wave reflects atrial depolarization, not ventricular activity. The PR interval measures conduction time from atrial depolarization through the AV node to the start of ventricular depolarization, so it is a timing interval rather than a ventricular depolarization waveform. The T wave represents ventricular repolarization, which follows contraction rather than initiating it.

Question 23

A 63-year-old client has Prinzmetal’s angina. To reduce the risk of coronary artery spasms, which type of medication is the physician most likely to prescribe?

Accepted Answer

Answer reason: Calcium channel blockers decrease calcium influx into vascular smooth muscle, producing coronary vasodilation and directly reducing spasm frequency. Beta-blockers do not treat the underlying vasospasm and nonselective agents may worsen spasm by leaving unopposed alpha-mediated vasoconstriction. ACE inhibitors are useful for hypertension/heart failure and vascular remodeling but are not primary agents for preventing coronary vasospasm in variant angina.

Question 24

A child diagnosed with tetralogy of Fallot has been ordered to undergo testing. Which test would best indicate the direction and amount of shunting in this child?

Accepted Answer

Answer reason: Cardiac catheterization provides definitive hemodynamic data (pressure gradients and step-up/step-down in O2 saturation) that allow calculation of shunt fraction and confirmation of right-to-left flow typical of tetralogy of Fallot. Echocardiography is excellent for anatomy and Doppler estimates of flow, but it is less definitive for precise shunt quantification than invasive hemodynamic assessment when exact direction/amount is required. Chest radiography and ECG can suggest secondary effects (cardiac size, pulmonary vascularity, chamber hypertrophy) but cannot determine shunt direction and amount.

Question 25

A nurse is teaching the parents of a child who was diagnosed with sinus bradycardia. Which statement about the condition is the most correct?

Accepted Answer

Answer reason: Sinus bradycardia is defined by a sinus rhythm with a rate below the expected normal range for the patient’s age, while maintaining normal conduction from the SA node through the AV node. In pediatrics, interpretation must be age-specific because normal heart rates vary widely across infancy, childhood, and adolescence. Options describing a rate greater than normal or increased SA node impulse formation instead describe sinus tachycardia/accelerated sinus activity. Calling it a “variation of the normal cardiac rhythm” is too nonspecific and can minimize a clinically relevant abnormal rate, especially if symptoms or hemodynamic compromise are present.

Question 26

Which statement by the nurse about bacterial or infective endocarditis is most accurate?

Accepted Answer

Answer reason:  Infective endocarditis is defined by microbial infection of the endocardium, most commonly involving the heart valves, producing vegetations and local tissue destruction. This option correctly identifies both the typical anatomic site (valves) and the involved layer (inner lining/endocardium). The statement that bacteria invade only heart tissues is too narrow because the condition can cause systemic emboli and immune phenomena beyond the heart. The fetal endocardial cushion fusion defect describes a congenital malformation, and preload/afterload/contractility changes relate to heart failure physiology rather than infection.

Question 27

A client’s rhythm strip shows a regular rhythm with atrial and ventricular rates of 70 beats/minute, a PR interval of 0.24 seconds, and a QRS duration of 0.08 seconds. The nurse interprets this rhythm as?

Accepted Answer

Answer reason: First-degree AV block is defined by a consistently prolonged PR interval (>0.20 seconds) with a regular rhythm and normal QRS duration. The rate of 70/min with matching atrial and ventricular rates supports a sinus origin rather than a junctional rhythm. A QRS duration of 0.08 seconds indicates normal intraventricular conduction, which fits an AV nodal delay rather than a bundle-branch block. Normal sinus rhythm would require a PR interval within 0.12–0.20 seconds, making it less accurate here. Sinus arrhythmia would show an irregular rhythm varying with respiration, which contradicts the stated regular rhythm.

Question 28

A client with angina pectoris has a stat electrocardiogram (ECG) performed during an episode of chest pain. The nurse reviews the ECG and notes myocardial ischemia. This would be displayed as?

Accepted Answer

Answer reason: Myocardial ischemia alters ventricular repolarization, producing characteristic ST-segment depression and/or T-wave inversion on the ECG. During angina (transient ischemia without necrosis), T-wave inversion is a classic ischemic change. Pathologic Q waves generally indicate established myocardial infarction with irreversible tissue necrosis rather than simple ischemia. Increased QRS duration and shortened PR interval more often reflect conduction system abnormalities, not ischemic changes.

Question 29

When caring for a child diagnosed with a ventricular septal defect, which description would the nurse incorporate when teaching the parents about this condition?

Accepted Answer

Answer reason: A ventricular septal defect is a congenital opening in the interventricular septum caused by incomplete formation of the septal tissue during development. This defect allows abnormal communication between the left and right ventricles, typically creating a left-to-right shunt that can lead to increased pulmonary blood flow and signs of heart failure when large. The option describing incomplete septal development between the atria instead defines an atrial septal defect. The narrowing options describe coarctation of the aorta (aortic arch narrowing) and pulmonic stenosis (pulmonary outflow valve narrowing), which are different congenital lesions.

Question 30

A nurse on a telemetry unit teaches a client diagnosed with acute coronary syndrome about coronary blood flow. Which of the following statements made by the nurse is correct?

Accepted Answer

Answer reason: Coronary perfusion is greatest when the myocardium is relaxed because intramyocardial pressure compresses coronary vessels during ventricular contraction. During systole, especially in the left ventricle, the coronary arteries are mechanically compressed, reducing forward flow despite high aortic pressure. In diastole, the aortic valve is closed and aortic diastolic pressure drives blood into the coronary circulation with less extravascular compression. This is why tachycardia (shortened diastole) can worsen ischemia in acute coronary syndrome. Options linking flow primarily to inspiration or breathing patterns are not the dominant physiologic determinant compared with the cardiac cycle phase.

Question 31

A client hospitalized with a pulmonary embolism develops hypotension. The nurse determines that the hypotension was the result of which of the following?

Accepted Answer

Answer reason: This decreases forward flow through the pulmonary circulation, so less blood reaches the left atrium and left ventricle, lowering preload and thus cardiac output and blood pressure. Hypotension in significant PE is therefore primarily a consequence of reduced left-sided filling rather than isolated “reduced blood flow to the lung.” Option C is less accurate because venous return to the right heart is not the key initial problem; the obstruction is after the right ventricle, impairing transmission of flow to the left heart.

Question 32

The parents of a newborn child have just been told that he has a heart defect known as patent ductus arteriosus. Which statement made by the parents indicates that teaching has been effective?

Accepted Answer

Answer reason:  Patent ductus arteriosus is persistence of the normal fetal connection between the aorta and pulmonary artery after birth; physiologically, this vessel is expected to functionally close soon after birth and become fully sealed over the following weeks. This option reflects the key teaching point that closure is normally expected within the early postnatal period (commonly cited as within several weeks). In PDA, left-to-right shunting increases pulmonary blood flow, so statements claiming decreased pulmonary blood flow or a cyanotic defect are inconsistent with typical PDA physiology. Heart failure is not “uncommon” in significant PDA because the excess pulmonary circulation can lead to volume overload and congestive heart failure.

Question 33

The nurse is discussing the pathophysiology of atherosclerosis with a client who has a high low-density lipoprotein (LDL) level. Which information should the nurse discuss with the clients concerning the pathophysiology of LDL?

Accepted Answer

Answer reason: LDL’s core physiologic role is to deliver cholesterol from the liver to peripheral tissues via LDL receptors, which is central to understanding how excess LDL contributes to atherosclerotic plaque formation. When circulating LDL is elevated, more LDL can enter the arterial intima, become oxidized, and be taken up by macrophages to form foam cells and fatty streaks. This makes LDL a key atherogenic lipoprotein rather than a “protective” one (that role is associated with HDL). The option about measuring free fatty acids and glycerol describes triglyceride metabolism rather than LDL, and diet advice is an intervention, not the pathophysiology of LDL itself.

Question 34

A client’s blood pressure is being checked at a health clinic. Which statement by the client demonstrates awareness of having a risk factor for hypertension?

Accepted Answer

Answer reason:  Hypertension risk is influenced by nonmodifiable factors such as family history, age, and certain population-level risk patterns that warrant closer screening. African American adults have a higher prevalence of hypertension and are at greater risk for earlier onset and complications, so increased monitoring reflects accurate risk awareness. A BMI of 23 is in the normal range and is not itself a risk factor. Moderate alcohol intake can contribute to elevated blood pressure depending on quantity and pattern, but the statement given does not clearly identify it as a recognized risk factor compared with the well-established epidemiologic risk noted in the correct choice.

Question 35

While the nurse is assessing the client, the client says, “I had an endovascular repair of an AAA that was found 1 month ago during a routine physical.” The nurse’s assessment of the client should be based on understanding that this procedure involves which action?

Accepted Answer

Answer reason: By sealing above and below the aneurysm, it diverts blood away from the aneurysm sac, reducing pressure on the weakened wall and lowering rupture risk. The aneurysm is not excised; it is effectively “excluded” from direct arterial flow. Descriptions involving removal of the aneurysm or external stenting/angioplasty do not match the mechanism of EVAR.

Question 36

Medical management of acute MI?

Accepted Answer

Answer reason: Primary PCI (balloon angioplasty with stent) is the preferred reperfusion strategy when it can be performed promptly by an experienced team. Surgical bypass is generally reserved for specific anatomy (e.g., left main disease) or failed PCI rather than first-line emergent therapy. Diagnostic catheterization alone does not treat the occlusion unless paired with PCI, and oral medications are supportive but do not achieve immediate reperfusion.

Question 37

Donated blood is taken from...?

Accepted Answer

Answer reason: Arterial puncture is avoided in routine donation due to higher pressure, greater bleeding risk, and increased chance of hematoma or vascular injury. Capillaries only yield small volumes used for fingerstick testing, not donation. Direct collection from the heart is not a standard or safe method for blood donation.

Question 38

Normal heart rate is around…?

Accepted Answer

Answer reason: A value around 72/min falls near the commonly cited average resting rate for healthy adults. Rates like 150/min suggest tachycardia, which is abnormal at rest and usually indicates stress, fever, hypovolemia, arrhythmia, or other pathology. Values of 10/min or 20/min are incompatible with adequate cardiac output in an adult and would indicate profound bradycardia or impending arrest.

Question 39

BP above 140/90 mHG is --?

Accepted Answer

Answer reason: This level is not compatible with normal blood pressure ranges and is the opposite of hypotension, which refers to abnormally low blood pressure. Shock is a clinical state of inadequate tissue perfusion and is typically associated with low blood pressure, not elevated readings. Therefore the option intended to represent hypertension best fits the definition given in the stem.

Question 40

Which of the following is the main preventive measure for stroke in patients with hypertension?

Accepted Answer

Answer reason: Tight, sustained reduction of arterial pressure has the largest evidence-based impact on lowering first-stroke risk in hypertensive patients. Smoking cessation is important for vascular risk reduction but is not the single main preventive measure specifically tied to hypertension-related stroke risk. High-protein diets and routine vitamin supplementation have no comparable proven stroke-prevention benefit in this context.

Question 41

A patient is experiencing sinus tachycardia with a current heart rate of 128. Which of the following in the patient’s scenario would not be a potential cause for the tachycardia?

Accepted Answer

Answer reason: A temperature of 39.7°C increases metabolic demand and catecholamine release, commonly raising heart rate. Hypotension (84/50) and elevated serum lactate both suggest shock/poor tissue perfusion, which also triggers a tachycardic compensation to maintain cardiac output. In contrast, vagal stimulation increases parasympathetic tone at the SA/AV nodes, slowing conduction and heart rate, making it inconsistent as a cause of tachycardia.

Question 42

A client reports substernal chest pain that radiates to the left arm. The pain began after climbing stairs and subsided after 5 minutes of rest. Vital signs are stable and ECG shows no ST elevation. Which physiological mechanism best explains this client’s symptoms?

Accepted Answer

Answer reason: Climbing stairs increases heart rate, contractility, and wall stress, raising oxygen demand beyond what a fixed atherosclerotic narrowing can supply, producing reversible ischemia. Resolution with rest indicates the ischemia is not prolonged enough to cause infarction, aligning with the absence of ST-elevation. In contrast, irreversible cell death or complete coronary occlusion would typically produce persistent pain and/or more significant ECG changes, and would not promptly resolve with rest.

Question 43

The normal range of the PR interval is?

Accepted Answer

Answer reason: 0.12 - 0.20 seconds The PR interval reflects atrial depolarization and AV nodal conduction time and is measured from the start of the P wave to the start of the QRS complex on an ECG. The accepted normal duration is 0.12–0.20 seconds (3–5 small boxes at 25 mm/s). Values shorter than 0.12 seconds suggest pre-excitation or junctional rhythms, while values longer than 0.20 seconds indicate first-degree AV block. Options expressed in minutes are physiologically incorrect for ECG interval measurement and represent a unit error.

Question 44

What is the normal range for an adult’s resting heart rate?

Accepted Answer

Answer reason: Values below 60 can be normal in well-conditioned athletes, but as a general reference range for adults it is considered bradycardia rather than the standard “normal range.” Rates above 100 at rest are classified as tachycardia and warrant assessment for causes such as fever, hypovolemia, pain, anxiety, hypoxia, or stimulant/medication effects. Therefore the 60–100 range best matches the accepted clinical vital-sign reference range used in nursing assessment.

Question 45

The Most common complaint by parents about infants with heart disease is that they have–?

Accepted Answer

Answer reason: Feeding is a high-energy activity for infants; inadequate systemic perfusion and early dyspnea lead to short, interrupted feeds and sweating or tachypnea during feeding. This symptom tends to appear earlier and be more readily observed than downstream consequences like growth failure or developmental delay. Recurrent respiratory infections can occur in some lesions with pulmonary overcirculation, but it is less consistently the earliest or most common presenting parental complaint compared with feeding difficulty.

Question 46

Which of the following findings is suggestive of right-sided heart failure?

Accepted Answer

Answer reason: This leads to blood backing up into the hepatic veins and liver, producing liver enlargement and tenderness. Respiratory findings like nasal flaring, tachypnea, and wheezing are more consistent with pulmonary pathology or left-sided failure with pulmonary congestion. The option that best reflects systemic venous congestion is therefore the enlarged liver finding.

Question 47

What is the main risk factor for Buerger's disease?

Accepted Answer

Answer reason: Tobacco triggers endothelial injury and an inflammatory thrombotic process, leading to distal ischemia, claudication, rest pain, and ulceration/gangrene. Complete cessation of all nicotine products is the most effective way to halt progression, making tobacco use the dominant risk factor tested. Diabetes and obesity are major contributors to peripheral arterial disease from atherosclerosis, but they are not the defining driver for thromboangiitis obliterans. Alcohol use is not a primary etiologic risk for this condition.

Question 48

A client with a history of smoking has an increased risk in the development of which of the following?

Accepted Answer

Answer reason: This directly increases the risk of peripheral arterial disease, a manifestation of systemic atherosclerotic vascular disease. In contrast, DVT is more strongly linked to venous stasis, hypercoagulability, and endothelial injury (e.g., immobility, surgery, malignancy) rather than smoking as a primary driver. Venous insufficiency is mainly due to valvular incompetence and chronic venous hypertension, and Raynaud disease is a vasospastic disorder with smoking being a trigger/worsener but not the classic primary risk association tested compared with atherosclerotic PAD.

Question 49

The nurse evaluates a client’s ECG. The ECG shows: A heart rate of 79 beats/min A regular rhythm in lead view II A constant PR interval of 0.12 Each P wave is uniform in shape Each P wave is followed by a QRS Where does the impulse for conduction of this rhythm originate?

Accepted Answer

Answer reason: These ECG findings indicate atrial depolarization is originating from the heart’s primary pacemaker with intact AV conduction. The sinoatrial node generates the impulse that spreads through the atria, producing consistent P waves before each QRS. In contrast, impulses from the AV node, bundle of His, or Purkinje system typically produce absent/abnormal P waves or different rates/rhythm patterns consistent with junctional or ventricular rhythms.

Question 50

What is the main function of the heart?

Accepted Answer

Answer reason: This is accomplished by coordinated atrial and ventricular contraction, maintaining cardiac output to perfuse tissues. Waste filtration is chiefly a renal function, nutrient absorption is a gastrointestinal function, and while the heart has minor endocrine activity (e.g., ANP), that is not its main physiologic purpose. Therefore the best answer is the option describing circulation support via mechanical pumping.

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