Rational: An atrial septal defect can lead to right-sided heart failure. Left-sided heart failure can result from a ventricular septal defect (Option A), an anterior MI (Option B), or constrictive pericarditis (Option D).
2.answer: C
Rational:The patient should make sure the head of the bed is slightly elevated to aid perfusion to the lower extremities. The patient shouldn’t massage his legs (Option A) because doing so could further damage tissue. Sitting for several hours a day (Option B) isn’t recommended.The patient should wear loose clothing, not constrictive clothing such as socks with tight elastic (Option D), to avoid compressing the vessels in the legs.
3 answer: B
Rational:ACE inhibitors reduce preload and afterload. Antiplatelet drugs minimize platelet aggregation (Option A). Nitrates reduce myocardial oxygen consumption (Option C). Beta-adrenergic blockers reduce the workload of the heart and myocardial oxygen demand
(Option D).
4.answer: B
Rational: Peripheral edema is a sign of fl uid volume overload and worsening heart failure.The other options (a skin rash, dry cough, and postural hypotension) are adverse reactions to captopril, but they don’t indicate that therapy isn’t effective.
5. answer: D
Rational: Erb’s point is located at the third intercostal space at the left sternal border.The fifth intercostal space near the midclavicular line (Option A) is used to listen to the mitral area. The fifth intercostal space along the left sternal border (Option B) is the location for the tricuspid area. The second intercostal space at the left sternal border (Option C) is the location for the pulmonic area.
6.Answer: C
Rational: MRI is a noninvasive procedure that aids in the diagnosis and detection of thoracic aortic aneurysm and evaluation of coronary artery disease, pericardial disease, and cardiac masses.Cardiac biopsy (Option A), cardiac catheterization (Option B), and pericardiocentesis (Option D) are invasive techniques used to evaluate cardiac changes.
7. Answer: D
Rational: In PVCs, the ECG shows a QRS complex followed by a compensatory pause that ends when the underlying rhythm resumes. Options A and B are ECG criteria used to evaluate atrial fibrillation. Option C is used to describe criteria for atrial flutter.
8. Answer: B
Rational: An S3 is heard following an S2, indicating that the patient is experiencing heart failure and results from increased fi lling pressures. Option A (S1) is a normal heart sound made by
the closing of the mitral and tricuspid valves. Option C (S4) is heard before S1 and is caused by resistance to ventricular fi lling. Option D (murmur of mitral insuffi ciency) occurs during systole and is heard when there’s turbulent blood fl ow across the valve.
9. Answer: B
Rational: Warfarin is at therapeutic levels when the patient’s PT is 1½ to 2 times the control.Higher values indicate increased risk of bleeding and hemorrhage, and lower values indicate increased risk of blood clot formation. Option A is incorrect because heparin, not warfarin, prolongs PTT. Option C is incorrect because although the INR may also be used to determine if warfarin is at a therapeutic level, an INR of 2 to 3 is considered therapeutic.Option D is incorrect because hematocrit doesn’t provide information on the effectiveness of warfarin; however, a falling hematocrit in a patient taking warfarin may be a sign of hemorrhage.
10. Answer: C
Rational: A blood pressure of 150/90 mm Hg should be rechecked within 2 weeks according to current recommendations. If confi rmed, assessment and treatment should be initiated by the practitioner.Option A is incorrect because although hypertension is more prevalent among blacks, a blood pressure of 150/90 mm Hg isn’t considered normal. Option B is incorrect because a person with a blood pressure of 150/90 mm Hg shouldn’t wait as long as 1 year to have it rechecked. Option D is incorrect because he doesn’t need to be treated on an emergency basis, but he should have his blood pressure monitored.
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