Cardiovascular system MCQ-1

• 1) Which of the below is NOT a function of the

fibrous skeleton of the heart?
A) Conducts the impulses from atria to ventricles
B) Acts as a point of insertion for cardiac muscle
fibers
C) Prevents overstretching of the valves
D) Forms a structural foundation for the heart
valves
C) Prevents overstretching of the valves
• 2) Gate keeper of the heart is
• A) SA Node
• B)AV node
• D) Purkinjee fibers
• E) Bundle of His
• The SA node generates electrical impulses at 60
to 100 times per minute and is controlled by the
sympathetic and parasympathetic nervous
system
• If the SA node fails, the AV node can initiate and
sustain a heart rate of 40 to 60 beats/minute.
• Purkinje fibers can act as the pacemaker with a
rate between 20 and 40 beats/minute when
higher pacemakers (such as the SA and AV nodes)
fail.
3) “Heart of heart” is ________
a) SA node
b) AV node
c) Bundle of HIS
d) Purkinji fibers
• 4) Inner most layer of heart
• A) Myocardium
• B) Pericardium
• C) Epicaridum
• D) Endocardium
5) Egg on side appearance is characteristic of?
• A. Tetralogy of fallot
• B. Total anomalous pulmonary venous
connection
• C. Patent ductus arteriosus
• D. Transposition of great arteries
 X ray signs and
conditions
X ray signs/ diagnostic Disease condition
signs
Boot shaped heart TOF
Egg on side appearance Transposition of Great arteries

Ground glass appearance RDS/HMD

Cottage- loaf sign/‘snow man’ or ‘ Total Anomalous Pulmonary Venous

figure of 8’ sign Connection

Box Shaped Heart Ebstein’s anomaly

Steeple sign Croup

Cherry red epiglottis on laryngoscopy Croup

Honey comb appearance Bronchiectasis

Flask shaped/pear shaped/money Pericardial effusion
bag/leather
bottle shaped heart
Jug handle appearance Primary pulmonary artery hypertension

3 like appearance Coarctation of aorta

Egg in cup appearance Constrictive pericarditis

Pericardial calcification Constrictive pericarditis

Bat’s wing appearance Pulmonary edema

Pruned tree appearance(of pulmonary Pulmonary artery hypertension

circulation)

Step ladder or stair case pattern in X ray Intussusception

5) A client is admitted to the emergency department with chest
pain that is consistent with myocardial infarction based on
elevated troponin levels. Heart sounds are normal and vital
signs are noted on the client’s chart. The nurse should alert
the health care provider because these changes are most
consistent with which complication? Refer to chart

a) Cardiogenic shock
b) Cardiac tamponade
c) Pulmonary embolism
d) Dissecting thoracic aortic
aneurysm
Cardiogenic shock occurs with severe damage (more
than 40%) to the left ventricle. Classic signs include
hypotension; a rapid pulse that becomes weaker;
decreased urine output; and cool, clammy skin.
Respiratory rate increases as the body develops
metabolic acidosis from shock.
Cardiac tamponade is accompanied by distant,
muffled heart sounds and prominent neck vessels.
Pulmonary embolism presents suddenly with severe
dyspnea accompanying the chest pain. Dissecting
aortic aneurysms usually are accompanied by back
pain
6) A client admitted to the hospital with chest
pain and a history of type 2 diabetes mellitus
is scheduled for cardiac catheterization.
Which medication would need to be withheld
for 24 hours before the procedure and for 48
hours after the procedure?
a. Glipizide
b.Metformin
c. Repaglinide
d.Regular insulin
7) True about stone heart syndrome?
A. Global ischemic contracture of the heart
B. Was more frequent in the early era of
cardiopulmonary bypass
C. Moderate hypothermia is useful in
prevention
D. All of the above
• Global ischemic contracture of the heart
resulting in a firm myocardium and loss of
intracavitary volume is termed stone heart
syndrome.
• It was described in the early years of open
heart surgery with cardiopulmonary bypass
• 8) The action of Furosemide in acute
pulmonary edema due acute left ventricular
failure is by:
• a) Pulmonary venodilation
• b) Increasing urine formation
• c) Decreases blood volume
• d) All of the above
• Frusemide is a loop diuretic.  It is also a
pulmonary venodilator.
•  In left ventricular failure, frusemide is given
intravenously.
•  It causes pulmonary venodilation and
relieves pulmonary congestion.
• Also by increasing urine formation, it
decreases blood volume and venous return
thus decreasing preload of the heart
• 9) Aclient in sinus bradycardia, with a heart
rate of 45 beats/minute, complains of
dizziness and has a blood pressure of 82/60
mm Hg. Which prescription should the nurse
anticipate will be prescribed?
• A) Administer digoxin.
• B) Defibrillate the client.
• C) Continue to monitor the client.
• D) Prepare for transcutaneous pacing
• Sinus bradycardia is noted with a heart rate less than 60 beats
per minute.
• This rhythm becomes a concern when the client becomes
symptomatic.
• Hypotension and dizziness are signs of decreased cardiac
output.
• Transcutaneous pacing provides a temporary measure to
increase the heart rate and thus perfusion in the symptomatic
client.
• Defibrillation is used for treatment of pulseless ventricular
tachycardia and ventricular fibrillation.
• Digoxin will further decrease the client’s heart rate.
Continuing to monitor the client delays necessary
intervention
11) X-ray appearance of calcification of patent
ductus arteriosus is?
A) Y shaped
B) Inverted Y shaped
C) V shaped
D) Inverted V shaped
13) client with myocardial infarction suddenly
becomes tachycardic, shows signs of air hunger,
and begins coughing frothy, pink-tinged sputum.
Which finding would the nurse anticipate when
auscultating the client’s breath sounds?
a) Stridor
b)Crackles
c) Scattered rhonchi
d)Diminished breath sounds
• Pulmonary edema is characterized by extreme
breathlessness, dyspnea, air hunger, and the
production of frothy, pink-tinged sputum.
• Auscultation of the lungs reveals crackles.
• Rhonchi and diminished breath sounds are
not associated with pulmonary edema.
• Stridor is a crowing sound associated with
laryngospasm or edema of the upper airway
obstruction
14) A client with myocardial infarction is
developing cardiogenic shock. Because of the
risk of myocardial ischemia, what condition
should the nurse carefully assess the client
for?
a)Bradycardia
b) Ventricular dysrhythmias
c) Rising diastolic blood pressure
d) Falling central venous pressure
• Classic signs of cardiogenic shock as they
relate to myocardial ischemia include low
blood pressure and tachycardia.
• The central venous pressure would rise as the
backward effects of the severe left ventricular
failure.
• Dysrhythmias commonly occur as a result of
decreased oxygenation and severe damage to
greater than 40% of the myocardium
• 15) The nurse is evaluating the condition of a
client after pericardiocentesis performed to
treat cardiac tamponade. Which observation
would indicate that the procedure was
effective?
• a) Muffled heart sounds
• b) A rise in blood pressure
• c) Jugular venous distention
• d)Client expressions of dyspnea
• Following pericardiocentesis, the client usually
expresses immediate relief.
• Heart sounds are no longer muffled or distant
and blood pressure increases
• Distended neck veins are a sign of increased
venous pressure, which occurs with cardiac
tamponade
• 16) The nurse is monitoring an infant with
congenital heart disease closely for signs of
heart failure (HF). The nurse should assess the
infant for which early sign of HF?
• A) Pallor
• B) Cough
• c) Tachycardia
• D) Slow and shallow breathing
• HF is the inability of the heart to pump a
sufficient amount of blood to meet the oxygen
and metabolic needs of the body.
• The early signs of HF include tachycardia,
tachypnea, profuse scalp sweating, fatigue and
irritability, sudden weight gain, and respiratory
distress.
• A cough may occur in HF as a result of mucosal
swelling and irritation, but is not an early sign.
• Pallor may be noted in an infant with HF, but is
not an early sign
17) The nurse reviews the laboratory results for
a child with a suspected diagnosis of
rheumatic fever, knowing that which
laboratory study would assist in confirming
the diagnosis?
a)Immunoglobulin
b) Red blood cell count
c) White blood cell count
d) Anti–streptolysin O tite
18) On assessment of a child admitted with a
diagnosis of acute-stage Kawasaki disease, the
nurse expects to note which clinical
manifestation of the acute stage of the
disease?
a)Cracked lips
b)Normal appearance
c) Conjunctival hyperemia
d) Desquamation of the skin
• Kawasaki disease, also known as mucocutaneous lymph node
syndrome, is an acute systemic inflammatory illness.
• The cause is unknown, but may be associated with an infection from
an organism or toxin.
• Cardiac involvement is the most serious complication; aneurysms
can develop.
• Acute stage
a. Fever b. Conjunctival hyperemia c. Red throat d. Swollen hands,
rash, and enlargement of cervical lymph nodes
• Subacute stage
• a. Cracking lips and fissures b. Desquamation of the skin on the tips
of the fingers and toes c. Joint pain d. Cardiac manifestations e.
Thrombocytosis
• 3. Convalescent stage: Child appears normal, but signs of
inflammation may be present
• 19) A health care provider has prescribed
oxygen as needed for an infant with heart
failure. In which situation should the nurse
administer the oxygen to the infant?
• A) During sleep
• B) When changing the infant’s diapers.
• C) When the mother is holding the infant
• D) When drawing blood for electrolyte level
testing
• Heart failure (HF) is the inability of the heart to pump a
sufficient amount of blood to meet the oxygen and
metabolic needs of the body.
• Crying exhausts the limited energy supply, increases the
workload of the heart, and increases the oxygen demands.
• Oxygen administration mayHeart failure (HF) is the
inability of the heart to pump a sufficient amount of blood
to meet the oxygen and metabolic needs of the body.
• Crying exhausts the limited energy supply, increases the
workload of the heart, and increases the oxygen demands.
Oxygen administration may
• 20) The following features are true for
tetralogy of Fallot, except:
A. Ventricular septal defect
B. Right ventricular hypertrophy
C. Atrial septal defect
D. Pulmonary stenosis
• 21) Blalock and Taussig shunt is done
between:
A. Aorta to pulmonary artery
B. Aorta to pulmonary vein
C. Subclavian artery to pulmonary vein
D. Subclavian vein to artery
• Blalock and Taussig shunt is used in the
surgical management of tetralogy of fallot.
• It is shunts blood from the subclavian artery
to the pulmonary artery
• As subclavian artery is a branch of aorta, the
best answer would be ‘aorta to pulmonary
artery.’
• 22) 1. Which of the following statements are
true of Coarctation of the aorta?
• (a) It usually presents with cyanosis and can be
detected with a drop in oxygen saturations from
pre to post ductal measurements
• (b) It typically presents with hypertension in the
legs in newborn babies
• (c) It can present with renal failure and lactic
acidosis as the duct closes
• (d) It is the commonest form of congenital heart
defect
• Coarctation of the aorta is localized narrowing near the
insertion of the ductus arteriosus.
• As the duct closes the blood flow to the descending
aorta beyond the constriction is dramatically reduced
resulting in poor organ perfusion and build up of tissue
hypoxia leading to lactic acidosis.
• With coarctation of the aorta, the blood pressure is
higher in the upper extremities than in the lower
extremities.
• In addition, bounding pulses in the arms, weak or
absent femoral pulses, and cool lower extremities may
be present
• 23) Reverse e sign seen in
• A) Coarctation of Aorta
• B) VSD
• C) ASD
• D) Patent ductus arteriosus
• 24) Double Shadow is seen in
a. Mitral Stenosis
b. IBD
c. Pinealoma
d. None of the above
• The double-density sign, also known as the double
right heart border, is seen on frontal chest radiographs
in the presence of left atrial enlargement, and occurs
when the right side of the left atrium extends behind
the right cardiac shadow, indenting the adjacent lung
and forming its own distinct silhouette 
• If large enough, the left atrium can actually reach
beyond the border of the right atrium; this is known
as atrial escape.
•  The right superior pulmonary vein can lead to a similar
appearance 
• 25) Hilar dance on fluoroscopy is seen in
cases of
a. ASD
b. Bronchiectasis
c. Both
d. None