Chapter 8: Chest Disorders

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. In mitral stenosis, p waves may suggest:

A. Left atrial enlargement
B. Right atrial enlargement
C. Left ventricle enlargement
D. Right ventricle enlargement

____ 2. Aortic regurgitation requires medical treatment for early signs of CHF with:
A. Beta blockers
B. ACE inhibitors
C. Surgery
D. Hospitalization

____ 3. A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include
exertional dyspnea. Angina equivalents are important because:
A. Women with ischemic heart disease many times do not present with chest pain
B. Some patients may have no symptoms or atypical symptoms. Diagnosis may only
be made at the time of an actual myocardial infarction
C. Elderly patients have the most severe symptoms
D. A & B only

____ 4. The best evidence rating drugs to consider in a post myocardial infarction patient include:
A. ASA, ACE/ARB, beta-blocker, aldosterone blockade
B. Ace, ARB, Calcium channel blocker, ASA
C. Long-acting nitrates, warfarin, ACE, and ARB
D. ASA, clopidogrel, nitrates

____ 5. A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on
heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm
without ST segment abnormalities. Your plan may include:
A. Echocardiogram
B. Exercise stress test
C. Cardiac catheterization
D. Myocardial perfusion imaging

____ 6. Preceding a stress test, the following lab work might include:
A. CBC and differential to differentiate ischemic heart disease from anemia
B. Liver enzymes to rule out underlying gall bladder disease
C. Thyroid studies to rule out hyperthyroidism
D. A & C only

____ 7. Which test is the clinical standard for the assessment of aortic stenosis?
A. Cardiac catheterization
B. Stress test
 C. Chest x-ray
D. Echocardiography

____ 8. What is the most common valvular heart disease in the older adult?
A. Aortic regurgitation
B. Aortic stenosis
C. Mitral regurgitation
D. Mitral stenosis

____ 9. On examination, what type of murmur can be auscultated with aortic regurgitation?
A. Austin flint
B. Systolic ejection
C. Soft S1 and a Loud S2
D. Loud S1

____ 10. Ischemic heart disease is:

A. Defined as imbalance between oxygen supply and demand.
B. Frequently is manifested as angina.
C. Leading cause of death in the elderly.
D. All of the above.

____ 11. Which test is the clinical standard for the assessment of aortic stenosis?
A. Cardiac catheterization
B. Stress test
C. Chest x-ray
D. Echocardiography

____ 12. The aging process causes what normal physiological changes in the heart?
A. The heart valve thickens and becomes rigid, secondary to fibrosis and sclerosis
B. Cardiology occurs along with prolapse of the mitral valve and regurgitation
C. Dilation of the right ventricle occurs with sclerosis of pulmonic and tricuspid
valves
D. Hypertrophy of the right ventricle

____ 13. An older adult may present with atypical clinical signs of pneumonia. The nurse practitioner needs to
be aware that the clustering of all of the following signs and symptoms may be indicative of
pneumonia in an older person except:
A. Bradycardia
B. Malaise
C. Anorexia
D. Confusion

____ 14. Which of the following statements is true concerning anti-arrhythmic drugs?
A. Amiodarone is the only one not associated with increased mortality and it has a
very favorable side effect profile.
B. Both long-acting and short-acting calcium channel blockers are associated with an
increased risk of cardiovascular morbidity and mortality.
C. Most anti-arrhythmics have a low toxic/therapeutic ratio and some are exceedingly
toxic.
 D. Anti-arrhythmic therapy should be initiated in the hospital for all patients.

____ 15. Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and
left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized
as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent,
aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to
left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go
away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no
murmurs. Which of the following differential diagnoses would be most likely?
A. Musculoskeletal chest wall syndrome with radiation
B. Esophageal motor disorder with radiation
C. Acute cholecystitis with cholelithiasis
D. Coronary artery disease with angina pectoris

____ 16. Jose M. is a 68-year-old man who presents to your primary care practice for a physical. Jose has had
type 2 diabetes mellitus for 5 years, diet controlled. His BMI is 32. Smoker, pack per day for 25
years. He denies other medical problems. Family history includes CAD, CABG x4 for father, now
deceased; CHF, type 2 diabetes mellitus, HT for mother. According to the AHA/ACC guidelines,
what stage is Jose?
A. Stage A
B. Stage B
C. Stage C
D. Stage D

____ 17. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for
evaluation of a persistent, daily cough with increased sputum production, worse in the morning,
occurring over the past three months. She tells you, “I have the same thing, year after year.” Which
of the following choices would you consider strongly in your critical thinking process?
A. Seasonal allergies
B. Acute bronchitis
C. Bronchial asthma
D. Chronic bronchitis

____ 18. The best way to diagnose structural heart disease/dysfunction non-invasively is:
A. Chest x-ray
B. EKG
C. Echocardiogram
D. Heart catheterization

____ 19. A common auscultatory finding in advanced CHF is:

A. Systolic ejection murmur
B. S3 gallop rhythm
C. Friction rub
D. Bradycardia

____ 20. The organism most commonly responsible for community-acquired pneumonia in older adults is:
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
 C. Proteus mirabilis
D. Streptococcus pneumonia

____ 21. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of
driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath,
with chest pain and a feeling of panic. Which of the following problems is most likely?
A. Pulmonary edema
B. Heart failure
C. Pulmonary embolism
D. Pneumonia
Chapter 8: Chest Disorders
Answer Section

MULTIPLE CHOICE

1. ANS: A PTS: 1
2. ANS: B PTS: 1
3. ANS: D PTS: 1
4. ANS: A PTS: 1
5. ANS: B PTS: 1
6. ANS: D PTS: 1
7. ANS: D PTS: 1
8. ANS: B PTS: 1
9. ANS: A PTS: 1
10. ANS: D PTS: 1
11. ANS: D PTS: 1
12. ANS: A PTS: 1
13. ANS: A PTS: 1
14. ANS: C PTS: 1
15. ANS: D PTS: 1
16. ANS: A PTS: 1
17. ANS: D PTS: 1
18. ANS: C PTS: 1
19. ANS: B PTS: 1
20. ANS: D PTS: 1
21. ANS: C PTS: 1