Which drug is taken in small doses on a continuing basis to reduce platelet adhesion?
acetylsalicylic acid (ASA)
What will a partial obstruction in a coronary artery likely cause?
Cigarette smoking is a risk factor in coronary artery disease because smoking:
reduces vasoconstriction and peripheral resistance
decreases serum lipid levels
promotes platelet adhesion
increases serum HDL levels
What does the term arteriosclerosis specifically refer to?
development of atheromas in large arteries
intermittent vasospasm in coronary arteries
degeneration with loss of elasticity and obstruction in small arteries
ischemia and necrosis in the brain, kidneys, and heart
Which of the following actions causes the atrioventricular valves to close?
increased intraventricular pressure
depolarization at the AV node
ventricular relaxation and backflow of blood
contraction of the atria
When stroke volume decreases, which of the following could maintain cardiac output?
decreased peripheral resistance
increased heart rate
decreased venous return
Each of the following compares the output of blood from the left and right ventricles with each contraction of a normal heart. Which is correct?
Left ventricular output is slightly greater than the right ventricular output.
Left ventricular output is approximately double that of right ventricular output.
Left ventricular output equals the right ventricular output.
Left ventricular output is less than right ventricular output.
Which of the following describes the pericardial cavity correctly?
It contains sufficient fluid to provide a protective cushion for the heart.
It is a potential space containing a very small amount of serous fluid.
It is lined by the endocardium.
It is located between the double-walled pericardium and the epicardium.
Which of the following factors greatly improves venous return to the heart during strenuous exercise?
rapid emptying of the right side of the heart
forceful action of the valves in the veins
contraction and relaxation of skeletal muscle
peristalsis in the large veins
What is the function of the baroreceptors? To:
stimulate the parasympathetic or sympathetic nervous systems at the SA node as needed
adjust blood pressure by changing peripheral resistance
sense a change in blood oxygen and carbon dioxide levels
signal the cardiovascular control center of changes in systemic blood pressure
The normal delay in conduction through the atrioventricular node is essential for:
preventing an excessively rapid heart rate
limiting the time for a myocardial contraction
allowing the ventricles to contract before the atria
completing ventricular filling
Which of the following results from increased secretion of epinephrine?
increased heart rate and force of contraction
decreased stimulation of the SA node and ventricles
vasoconstriction in skeletal muscles and kidneys
vasodilation of cutaneous blood vessels
Which of the following causes increased heart rate?
stimulation of the vagus nerve
increased renin secretion
administration of beta-blocking drugs
Stimulation of the sympathetic nervous system
Which event causes the QRS wave on an ECG tracing?
What is the cardiac reserve?
the difference between the apical and radial pulses
the ability of the heart to increase cardiac output when needed
the extra blood remaining in the heart after it contracts
What does the term preload refer to?
volume of venous return
Which are the first arteries to branch off the aorta?
common carotid arteries
Vasodilation in the skin and viscera results directly from:
decreased blood pressure
increased parasympathetic stimulation
relaxation of smooth muscle in the arterioles
increased stimulation of alpha-adrenergic receptors
Which of the following drugs decrease sodium and fluid retention in the body?
hydrochlorothiazide (Hydro DIURIL)
Which of the following are predisposing factors to thrombus formation in the circulation?
1. decreased viscosity of the blood
2. damaged blood vessel walls
4. prosthetic valves
1, 3, 4
2, 3, 4
Modifiable factor that increase the risk for atherosclerosis include:
sedentary life style
female more than 40 years of age
exclusion of saturated fats from the diet
An atheroma develops from:
a torn arterial wall and blood clots
accumulated lipids, cells, and fibrin where endothelial injury has occurred
thrombus forming on damaged walls of veins
Low-density lipoproteins (LDL):
promote atheroma development
contain only small amounts of cholesterol
transport cholesterol from cells to the liver for excretion
are associated with low intake of saturated fats
Factors that may precipitate an angina attack include all of the following EXCEPT:
eating a large meal
an angry argument
walking down stairs
shovelling snow on a cold, windy day
When comparing angina with myocardial infarction (MI), which statement is true?
Both angina and MI cause tissue necrosis.
Angina often occurs at rest; MI occurs during a stressful time.
Pain is more severe and lasts longer with angina than with MI.
Angina pain is relieved by rest and intake of nitroglycerin; the pain of MI is not.
Which of the following best describes the basic pathophysiology of myocardial infarction?
Cardiac output is insufficient to meet the needs of the heart and body.
Temporary vasospasm occurs in a coronary artery.
Total obstruction of a coronary artery causes myocardial necrosis.
Heart rate and force is irregular, reducing blood supply to coronary arteries.
Which of the following are typical early signs or symptoms of myocardial infarction?
brief, substernal pain radiating to the right arm, with labored breathing
persistent chest pain radiating to the left arm, pallor, and rapid, weak pulse
bradycardia, increased blood pressure, and severe dyspnea
flushed face, rapid respirations, left-side weakness, and numbness
Which statement describes a coronary artery bypass procedure?
removing the section of an artery containing plaque and thrombus
compressing the thrombus with an inflated balloon to provide a larger lumen
attaching a section of vein to the coronary artery proximal and distal to the obstruction
adding a piece of vein to the end of each coronary artery
Calcium-channel blocking drugs are effective in:
reducing the risk of blood clotting
decreasing the attraction of cholesterol into lipid plaques
reducing cardiac and smooth muscle contractions
decreasing all types of cardiac arrhythmias
Which of the following confirms the presence of a myocardial infarction?
a full description of the pain
the presence of elevated serum cholesterol and triglycerides
characteristic patterns for serum isoenzymes and the ECG
leukocytosis and elevated C-reactive protein
The size of the necrotic area resulting from myocardial infarction may be minimized by all of the following EXCEPT:
previously established collateral circulation
immediate administration of thrombolytic drugs
maintaining maximum oxygen supply to the myocardium
removing the predisposing factors to atheroma development
What is the most common cause of death immediately following a myocardial infarction?
congestive heart failure
Why does ventricular fibrillation result in cardiac arrest?
Delayed conduction through the AV node blocks ventricular stimulation.
Insufficient blood is supplied to the myocardium.
The ventricles contract before the atria.
Parasympathetic stimulation depresses the SA node.
What does the term cardiac arrest mean?
cardiac output is less than the demand
decreased circulating blood volume
missing a ventricular contraction
cessation of all cardiac function
Which change results from total heart block?
a prolonged PR interval
periodic omission of a ventricular contraction
a wide QRS wave
spontaneous slow ventricular contractions, not coordinated with atrial contraction
What does the term PVC mean?
Atrial muscle cells are stimulating additional cardiac contractions.
The ventricles contract spontaneously following a period without a stimulus.
Additional contractions arise from ectopic foci in the ventricular muscle.
Increased heart rate causes palpitations.
Which of the following is most likely to cause left-sided congestive heart failure?
incompetent tricuspid heart valve
chronic pulmonary disease
infarction in the right atrium
uncontrolled essential hypertension
Which is the best definition of congestive heart failure?
cessation of all cardiac activity
inability of the heart to pump enough blood to meet the metabolic needs of the body
insufficient circulating blood in the body
the demand for oxygen by the heart is greater than the supply
Which of the following are significant signs of right-sided congestive heart failure?
severe chest pain and tachycardia
edematous feet and legs with hepatomegaly
frequent cough with blood-streaked frothy sputum
orthopnea, fatigue, increased blood pressure
Paroxysmal nocturnal dyspnea is marked by:
hemoptysis and rales
distended neck veins and flushed face
bradycardia and weak pulse
Which of the following occur as compensation mechanisms for decreased cardiac output in cases of congestive heart failure?
slow cardiac contractions
increased renin and aldosterone secretions
decreased erythropoietin secretion
fatigue and cold intolerance
In which blood vessels will failure of the left ventricle cause increased hydrostatic pressure?
veins of the legs and feet
blood vessels of the liver and spleen
Which of the following drugs improves cardiac efficiency by slowing the heart rate and increasing the force of cardiac contractions?
In an infant, which of the following is frequently the initial indication of congestive heart failure?
distended neck veins
low-grade fever and lethargy
Which of the following effects may be expected from a beta-adrenergic blocking drug?
increasing systemic vasoconstriction
decreased sympathetic stimulation of the heart
blockage of an angiotensin receptor site
increased release of renin
Which of the following is a sign of aortic stenosis?
increased cardiac output
congestion in the liver, spleen, and legs
flushed face and headache
a heart murmur
What would an incompetent mitral valve cause?
increased blood to remain in the right atrium
hypertrophy of the right ventricle
decreased output from the left ventricle
decreased pressure in the left atrium
Which of the following describes the blood flow occurring with a ventricular septal defect?
from the left ventricle to the right ventricle
from the right ventricle to the left ventricle
increased cardiac output from the left ventricle
mixed oxygenated and unoxygenated blood in the systemic circulation
In children with tetralogy of Fallot, why does unoxygenated blood enter the systemic circulation?
The aorta and pulmonary artery have exchanged positions.
Pulmonary stenosis changes the ventricular pressures.
The left ventricular wall has hypertrophied.
The septal defect allows exchange of blood between the atria.
Why does cyanosis occur in children with tetralogy of Fallot?
More carbon dioxide is present in the circulating blood.
A large amount of hemoglobin in the general circulation is unoxygenated.
The pulmonary circulation is overloaded and congested.
The circulation is sluggish (slow) throughout the system.
Which of the following represent(s) the pathophysiologic changes in the heart in cases of rheumatic fever?
infection in the heart by hemolytic streptococci
highly virulent microbes causing vegetations on the heart valves
septic emboli obstructing coronary arteries
an abnormal immune response, causing acute inflammation in all layers of the heart
Common signs of rheumatic fever include all of the following EXCEPT:
arthritis causing deformity of the small joints in the hands and feet
erythematous skin rash and subcutaneous nodules
epistaxis, tachycardia, and fever
elevated ASO titer and leukocytosis
How does rheumatic heart disease usually manifest in later years?
swollen heart valves and fever
cardiac arrhythmias and heart murmurs
thrombus formation and septic emboli
petechial hemorrhages of the skin and mucosa
Why are septic emboli a common complication of infective endocarditis?
Vegetations are loosely attached and fragile.
The valves are no longer competent.
Cardiac output is reduced.
Heart contractions are irregular.
Which of the following apply to subacute infective endocarditis?
A microbe of low virulence attacks abnormal or damaged heart valves.
Virulent microbes invade normal heart valves.
No permanent damage occurs to the valves.
Prophylactic medication does not prevent infection.
Why does pericarditis cause a reduction in cardiac output?
Delays in the conduction system interfere with cardiac rhythm.
Due to friction rub, the myocardial contractions are weak.
Excess fluid in the pericardial cavity decreases ventricular filling.
Incompetent valves allow regurgitation of blood.
Which of the following may cause pericarditis?
2. abnormal immune responses
4. malignant neoplasm
1, 2, 3, 4
Which of the following could be the source of an embolus causing an obstruction in the brain?
What is considered to be the basic pathophysiologic change in essential hypertension?
development of lipid plaques in large arteries
recurrent inflammation and fibrosis in peripheral arteries
degeneration and loss of elasticity in arteries
increased systemic vasoconstriction
Where is uncontrolled hypertension most likely to cause ischemia and loss of function?
kidneys, brain, and retinas of the eye
peripheral arteries in the legs
aorta and coronary arteries
liver, spleen, and stomach
When is a diagnosis of essential hypertension likely to be considered in young or middle-aged individuals?
blood pressure remains consistently above 140/90
blood pressure fluctuates between 130/ 85 and 180/105
blood pressure increases rapidly and is unresponsive to medication
chronic kidney disease leads to consistently elevated blood pressure
What is atherosclerosis in the iliac or femoral arteries likely to cause?
1. gangrenous ulcers in the legs
2. strong rapid pulses in the legs
3. intermittent claudication
4. red, swollen legs
What does the term intermittent claudication refer to?
sensory deficit in the legs due to damage to nerves
chest pain related to ischemia
ischemic muscle pain in the legs, particularly with exercise
dry, cyanotic skin with superficial ulcers
What is the primary reason for amputation of gangrenous toes or feet in patients with peripheral vascular disease?
promotes more rapid healing of ulcerated areas
improves circulation to other areas
prevents spread of infection and reduces pain
reduces swelling in the peripheral areas
An echocardiogram is used to demonstrate any abnormal:
activity in the conduction system
movement of the heart valves
change in central venous pressure
blood flow in coronary arteries
A friction rub is associated with:
an incompetent aortic valve
How does a dissecting aortic aneurysm develop?
A dilation or bulge develops at one point on the aortic wall.
Thrombus accumulates at a point in the aortic wall.
A section of the aorta weakens and dilates in all directions.
A tear in the intimal lining allows blood flow between layers of the aortic wall.
What is the outcome for many aortic aneurysms?
early diagnosis and repair
thrombus formation and pulmonary embolus
rupture and hemorrhage
pressure on adjacent organs or structures
Which factor predisposes to varicose veins during pregnancy?
compressed pelvic veins
stenotic valves in leg veins
insufficient muscle support for veins
Phlebothrombosis is more likely to cause pulmonary emboli than is thrombophlebitis because:
platelets attach to the inflamed wall
thrombus forms in a vein and is asymptomatic
leg cramps require massage
systemic signs of inflammation require treatment
How is shock defined?
failure of the heart to supply sufficient blood to body cells
general hypoxia causing damage to various organs
decreased circulating blood and tissue perfusion
loss of blood causing severe hypoxia
When does shock follow myocardial infarction?
The stress response causes general vasodilation.
Fluid is lost into ischemic tissues.
Heart valves are damaged.
A large portion of the myocardium is damaged.
What are the early signs of circulatory shock?
1. pale moist skin
2. loss of consciousness
3. anxiety and restlessness
4. rapid strong pulse
What indicates compensation for shock?
increased heart rate and oliguria
lethargy and decreased responsiveness
warm, dry, flushed skin
weak, thready pulse
Why does anaphylactic shock cause severe hypoxia very quickly?
Generalized vasoconstriction reduces venous return.
Bronchoconstriction and bronchial edema reduce airflow.
Heart rate and contractility are reduced.
Metabolic rate is greatly increased.
Why does neurogenic (vasogenic) shock result from systemic vasodilation?
increased peripheral resistance and less blood in the microcirculation
increased permeability of all the blood vessels leading to hypovolemia
slower, less forceful cardiac contractions
increased capacity of the vascular system and reduced venous return
What is a prolonged period of shock likely to cause?
damage and increased permeability of pulmonary capillaries
increased permeability of the glomerular capillaries of the kidneys
increased pH of blood and body fluids
Increased systemic vasoconstriction
What would indicate decompensated acidosis related to shock?
serum bicarbonate level below normal
PCO2 above normal
serum pH below normal range
urine pH of 4.5
With shock, anaerobic cell metabolism and decreased renal blood flow cause:
decreased serum potassium
increased serum bicarbonate
Why does shock develop in patients with severe burns?
pain and loss of plasma
direct damage to the heart
extensive hemolysis of erythrocytes
The classic early manifestation(s) of left-sided congestive heart failure are ____, whereas the early indicator(s) of right-sided failure are _______.
palpitations and periodic chest pain; shortness of breath on exertion
swelling of the ankles and abdomen; chest pain
shortness of breath on exertion or lying down; swelling of the ankles
coughing up frothy sputum; hepatomegaly and splenomegaly
Which is a common adverse effect of many antihypertensive medications?
altered blood coagulation
The cause of essential hypertension is considered to be:
chronic renal disease
excessive intake of saturated fats and salt
For which of the following would a cardiac pacemaker likely be inserted?
Which of the following is considered to be the most dangerous arrhythmia?
second-degree heart block
Which of the following is NOT true of the drug nitroglycerin?
It decreases myocardial workload by causing systemic vasodilation.
It may be administered sublingually, transdermally, or by oral spray.
Dizziness or syncope may follow a sublingual dose.
It strengthens the myocardial contraction.
Which of the following would confirm the diagnosis of a myocardial infarction?
1. specific changes in the ECG
2. marked leukocytosis and increased ESR
3. elevation of cardiac isoenzymes in serum
4. pattern of pain
Which of the following statements regarding aneurysms is true?
Aneurysms are always caused by congenital malformations.
The greatest danger with aneurysms is thrombus formation.
Manifestations of aneurysms result from compression of adjacent structures.
Aneurysms involve a defect in the tunica media of veins.
What is the most common factor predisposing to the development of varicose veins?
congenital valve defect in the abdominal veins
increased venous pressure
In the period immediately following a myocardial infarction, the manifestations of pallor and diaphoresis, rapid pulse, and anxiety result from:
onset of circulatory shock
the inflammatory response
release of enzymes from necrotic tissue
Septic shock differs from hypovolemic shock in that it is frequently manifested by:
fever and flushed face
elevated blood pressure
increased urinary output
slow bounding pulse
Heart block, in which a conduction delay at the AV node results in intermittent missed ventricular contractions, is called:
total heart block
More extensive permanent damage is likely when a myocardial infarction is caused by:
A very rapid heart rate reduces cardiac output because:
venous return is increased.
ventricular fibrillation develops immediately.
conduction through the AV node is impaired.
ventricular filling is reduced.
The right side of the heart would fail first in the case of:
1. severe mitral valve stenosis
2. uncontrolled essential hypertension
3. large infarction in the right ventricle
4. advanced COPD
Which of the following compensations that develop in patients with congestive heart failure eventually increase the workload of the heart?
faster heart rate and cardiomegaly
increased secretion of renin
a and c
a, b, and c
Which statement applies to paroxysmal nocturnal dyspnea?
It indicates decreased CO2 diffusion in the lungs.
It indicates swelling in the bronchioles and bronchi.
It is caused by increased blood in the lungs when lying in a supine position.
It results from pleural effusion.
In patients with congestive heart failure, ACE inhibitor drugs are useful because they:
reduce renin and aldosterone secretion
slow the heart rate
strengthen myocardial contraction
In a child with ventricular septal defect, altered blood flow:
leads to increased stroke volume from the left ventricle
results in unoxygenated blood in the systemic circulation
is called a right-to-left shunt
is called a left-to-right shunt
In a child with acute rheumatic fever, arrhythmias may develop due to the presence of:
Prophylactic antibacterial drugs such as amoxicillin are given to those with certain congenital heart defects or damaged heart valves immediately before invasive procedures to prevent:
formation of septic thrombi
Varicose ulcers may develop and be slow to heal because:
leg muscles are painful, restricting movement
edema reduces arterial blood supply to the area
emboli form in damaged veins leading to local ischemia
valves in veins restrict blood flow
Excessive fluid in the pericardial space causes:
reduced venous return
Aortic stenosis means the aortic valve:
allows blood to leak back into the left ventricle during diastole
cannot fully open during systole
functions to increase stroke volume
does not respond to the cardiac cycle
Which of the following would be the most likely cause of an iatrogenic disease?
an inherited disorder
a combination of specific etiologic factors
an unwanted effect of a prescribed drug
prolonged exposure to toxic chemicals in the environment
The manifestations of a disease are best defined as the:
subjective feelings of discomfort during a chronic illness
signs and symptoms of a disease
factors that precipitate an acute episode of a chronic illness
early indicators of the prodromal stage of infection
The best definition of the term prognosis is the:
precipitating factors causing an acute episode
number of remissions to be expected during the course of a chronic illness
predicted outcome or likelihood of recovery from a specific disease
exacerbations occurring during chronic illness
Which of the following is considered a systemic sign of disease?
swelling of the knee
pain in the neck
red rash on the face
Etiology is defined as the study of the:
causes of a disease
course of a disease
expected complications of a disease
manifestations of a disease
Hypertrophy of the heart would be related to:
an increase in the size of the individual cells
an increase in the number of cells in an area
replacement of normal cells by a different type of cell
a decrease in the size of the individual cells
A change in a tissue marked by cells that vary in size and shape and show increased mitotic figures would be called:
When a group of cells in the body dies, the change is called:
Lack of exercise during an illness may cause skeletal muscle to undergo:
The term cancer refers to:
To which of the following does the term apoptosis refer?
an increased rate of mitosis by certain cells
ischemic damage to cells
liquefaction of neurotic tissue
preprogrammed cell self-destruction
Which of the following statements is TRUE?
Alteration of DNA does not change cell function.
Damaged cells may be able to repair themselves.
All types of cells die at the same rate.
Mild ischemia causes immediate cell death.
Caseation necrosis refers to an area where:
cell proteins have been denatured
cell are liquefied by enzymes
dead cells form a thick cheesy substance
bacterial invasion has occurred
Routine application of sun block to skin would be an example of:
an iatrogenic cause of cancer
a preventative measure
a precipitating factor
a predisposing condition
A circumstance that causes a sudden acute episode of a chronic disease to occur is termed:
What is an acute episode of a chronic disease called?
a prodromal period
The term homeostasis refers to:
the causative factors in a particular disease
maintenance of a stable internal environment
a condition that triggers an acute episode
a collection of signs and symptoms
Which term is used to describe a new and secondary or additional problem that arises after the original disease is established?
Pathophysiology involves the study of:
the structure of the human body
the functions of various organs in the body
functional or structural changes resulting from disease processes
various cell structures and related functions
Which of the following is the best definition of epidemiology?
the science of tracking the occurrence and distribution of diseases
the relative number of deaths resulting from a particular disease
identification of a specific disease through evaluation of signs and symptoms
the global search for emerging diseases
Which of the following can cause cell injury or death?
2. exposure to excessive cold
3. excessive pressure on a tissue
4. chemical toxins
All of the following are part of the Seven Steps to Health EXCEPT:
follow cancer screening guidelines
use sun block agents whenever exposed
participate in strenuous exercise on a regular daily basis
choose high fiber, lower fat foods
avoid second hand smoke at all times
The term disease refers to:
the period of recovery and return to a normal healthy state
the relative number of deaths during an epidemic
the treatment measures used to promote recovery
a basic collection of signs and symptoms
a deviation from the normal state of health and function
The best definition of ischemia is:
the mechanical damage due to pressure on tissue
any imbalance of fluids or electrolytes in the body
a deficit of oxygen supply to the cells, due to circulatory obstruction
the effects of infection by microorganisms
All of the following statements are correct about cell damage EXCEPT:
The Initial stage of cell damage often causes an alteration in metabolic reactions.
If the factor causing the damage is removed quickly, the cell may be able to recover and return to its normal state.
If the noxious factor remains for an extended period of time, the damage becomes irreversible and the cell dies.
Initially cell damage does not change cell metabolism, structure, or function.
Which of the following conditions distinguishes double blind studies used in health research?
Neither the members of the control group or the experimental group nor the person administering the treatment know who is receiving the experimental therapy.
Both groups of research subjects and the person administering the treatment know who is receiving the experimental therapy.
The research subjects do not know, but the person administering the treatment knows who is receiving placebo or standard therapy.
Only members of the control group know they are receiving standard therapy.
If the data collected from the research process confirm that the new treatment has increased effectiveness and is safe, this is called:
the placebo effect
evidence based research
blind research studies
approval for immediate distribution
A short-term illness that develops very quickly with perhaps a high fever or severe pain is called:
The term prognosis refers to the:
period of recovery and return to a normal state
expected outcome of the disease
mortality and morbidity rates for a given population
typical collection of signs and symptoms
When prolonged ischemia occurs to an area of the heart, the resulting damage is referred to as:
During the evaluation process for a new therapy’s effectiveness and safety, a double blind study may be conducted during:
the first stage
the second stage
the third stage
any of these stages
Why are the predisposing factors for a specific disease important to health professionals?
to predict the prognosis
to determine treatments
to develop preventative measures
to develop morbidity statistics
Cell damage may be caused by exogenous sources such as:
abnormal metabolic processes
certain food additives
Which of the following is usually included in a medical history?
1. past illnesses or surgeries
2. current illnesses, acute and chronic
3. prescribed medication or other treatments
4. nonprescription drugs and herbal remedies
5. current allergies
2, 4, 5
1, 2, 3, 4, 5