Which of the following blood tests is most indicative of cardiac damage?
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Solution
Troponin I
Option C: 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.
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.
Option B: CBC is obtained to review blood counts, and a complete chemistry is obtained to review electrolytes.
Option D: Because CK levels may rise with skeletal muscle injury, CK isoenzymes are required to detect cardiac injury.
A murmur is heard at the second left intercostal space along the left sternal border. Which valve area is this?
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Solution
Pulmonic
Option C: Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal border.
Option A: Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum.
Option B: Mitral valve abnormalities are heard at the fifth intercostal space in the midclavicular line.
Option D: Tricuspid valve abnormalities are heard at the third and fourth intercostal spaces along the sternal border.
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?
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Solution
Pulmonary
Option D: Pulmonary pain is generally described by these symptoms.
Option C: Musculoskeletal pain only increases with movement.
Options A and B: Cardiac and GI pains don’t change with respiration.
Which of the following landmarks is the correct one for obtaining an apical pulse?
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Solution
Left fifth intercostal space, midclavicular line
Option B: 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 C: The left second intercostal space in the midclavicular line is where the pulmonic sounds are auscultated.
Option A and D: Normally, heart sounds aren’t heard in the midaxillary line or the seventh intercostal space in the midclavicular line.
Which of the following is the most common symptom of myocardial infarction?
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Solution
Chest pain
Option A: The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart.
Option B: Dyspnea is the second most common symptom, related to an increase in the metabolic needs of the body during an MI.
Option C: Edema is a later sign of heart failure, often seen after an MI.
Option D: Palpitations may result from reduced cardiac output, producing arrhythmias.
Prolonged occlusion of the right coronary artery produces an infarction in which of the following areas of the heart?
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Solution
Inferior
Option C: The right coronary artery supplies the right ventricle or the inferior portion of the heart. Therefore, prolonged occlusion could produce an infarction in that area.
Options A, B, and D: The right coronary artery doesn’t supply the anterior portion (left ventricle), lateral portion (some of the left ventricle and the left atrium), or the apical portion (left ventricle) of the heart.
Medical treatment of coronary artery disease includes which of the following procedures?
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Solution
Oral medication administration
Option C: Oral medication administration is a noninvasive, medical treatment for coronary artery disease.
Option A: Cardiac catheterization isn’t a treatment but a diagnostic tool.
Options B and D: Coronary artery bypass surgery and percutaneous transluminal coronary angioplasty are invasive, surgical treatments.
Which of the following actions is the first priority care for a client exhibiting signs and symptoms of coronary artery disease?
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Solution
Enhance myocardial oxygenation
Option B: 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 C: Sublingual nitroglycerin is administered to treat acute angina, but its administration isn’t the first priority.
Options A and D: Although educating the client and decreasing anxiety are important in care delivery, neither are priorities when a client is compromised.
Exceeding which of the following serum cholesterol levels significantly increases the risk of coronary artery disease?
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Solution
200 mg/dl
Option D: 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.
Which of the following risk factors for coronary artery disease cannot be corrected?
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Solution
Heredity
Option C: 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.
Option B: Diabetes mellitus is a risk factor that can be controlled with diet, exercise, and medication.
Option D: Altering one’s diet, exercise, and medication can correct hypertension.