Of the four basic cell types of lung cancer listed below, which is always associated with smoking?
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Solution
squamous cell carcinoma (epidermoid)
Option B: Textbooks of medicine and nursing classify primary pulmonary carcinoma somewhat differently. However most agree that squamous cell or epidermoid carcinoma is always associated with cigarette smoking.
The most common lethal cancer in males between their fifth and seventh decades is:
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Solution
cancer of the lung
Option B: The incidence of lung cancer is also rapidly rising in women.
You are seeing more clients with diagnoses of mitral valve prolapse. You know those mitral valve prolapse is usually a benign cardiac condition, but may be associated with atypical chest pain. This chest pain is probably caused by:
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Solution
papillary muscle ischemia and dysfunction
Option A: Ventricular ischemia does not occur with prolapsed mitral valve.
Options B and D: These are not painful conditions in themselves.
On physical exam of Ms. Baker, several abnormal findings can be observed. Which of the following is not one of the usual objective findings associated with mitral stenosis?
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Solution
chest x-ray showed left ventricular hypertrophy
Option D: Evidence of left atrial enlargement may be seen on chest x-ray and ECG.
Options A, B, and C: The other objective findings may be seen in chronic mitral stenosis with episodes of atrial fibrillation and right heart failure.
Sally Baker, a 40-year-old woman, is admitted to the hospital with an established diagnosis of mitral stenosis. She is scheduled for surgery to repair her mitral valve.
16. Ms. Baker has decided to have surgical correction of her stenosed valve at this time because her subjective complaints of dyspnea, hemoptysis, orthopnea, and paroxysmal nocturnal dyspnea have become unmanageable. These complaints are probably due to:
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Solution
pulmonary hypertension
Option C: Pulmonary congestion secondary to left atrial hypertrophy causes these symptoms.
Option D: The left ventricle does not hypertrophy in mitral stenosis.
Option B: Right heart failure would cause abdominal discomfort and peripheral edema.
Option A: Pericardial thickening does not occur.
The coronary arteries furnish blood supply to the myocardium. Which of the following is a true statement relative to the coronary circulation?
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Solution
the left coronary artery has two main branches, the left anterior descending and left circumflex: both supply the left ventricle
Option D: The right and left coronary arteries are the only branches off the ascending aorta; blood enters these arteries mainly during diastole; the right coronary artery also often supplies a small portion of the left ventricle.
The pulmonic component of which heart sound is best heard at the 2nd LICS at the LSB?
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Solution
S2
Option A: S1 is caused by mitral and tricuspid valve closure;
Option B: S2 is caused by the aortic and pulmonic valve closure;
Options C and D: S3 and S4 are generally considered abnormal heart sounds in adults and are best heard at the apex.
During the physical examination of the well adult client, the health care provider auscultates the heart. When the stethoscope is placed on the 5th intercostal space along the left sternal border, which valve closure is best evaluated?
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Solution
Tricuspid
Option A: The sound created by closure of the tricuspid valve is heard at the 5th LICS at the LSB.
Option B: Pulmonic closure is best heard at the 2nd LICS, LSB.Option C: Aortic closure is best heard at the 2nd RICS, RSB.
Option D: Mitral valve closure is best heard at the PMI landmark (apex)
The point of maximal impulse (PMI) is an important landmark in the cardiac exam. Which statement best describes the location of the PMI in the healthy adult?
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Solution
Apex of the heart, intercostal space, 7-9 cm to the left of the midsternal line.
Option C: The PMI is the impulse at the apex of the heart caused by the beginning of ventricular systole. It is generally located in the 5th left ICS, 7-9 cm from the MSL or at, or just medial to, the MCL.
Numerous drugs have been used on Mr. Kaplan in an attempt to stabilize him. Regarding his diagnosis and management of his drugs, you know that:
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Solution
Drug toxicity is a major concern in uremia; individualization of therapy and often a decrease in dose is essential.
Option B: Metabolic changes and alterations in excretion put the client with uremia at risk for development of toxicity to any drug. Thus alteration in drug schedule and dosage is necessary for safe care.