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Cardiovascular system

1. Ms. Thompson, a 58-year-old woman with a known history of cardiac issues, is sitting in the waiting room of her clinic. She has hypercholesterolemia and a family history of anxiety disorders on her father’s side. She has been taking medication to manage her cholesterol, and recently, she has noticed some leg discomfort as a side effect. Today, she feels unusually tense, a sensation she doesn’t typically experience. Suddenly, Ms. Thompson begins to feel a sharp pain in her chest, radiating to her left arm, accompanied by sweating and increasing paleness. The Licensed Practical Nurse (LPN) working at the clinic notices Ms. Thompson’s discomfort and immediately places her on a stretcher. Following clinic protocol, the LPN administers a dose of nitroglycerin spray, while an ambulance is called to transport Ms. Thompson to the emergency room. The physician suspects a possible myocardial infarction (heart attack). Which of the following clinical manifestations relates to the patient’s condition? *
2. Mr. Harris, a 52-year-old patient with a history of high blood pressure, has been admitted to the medical unit with a diagnosis of congestive heart failure (CHF). He mentions to the Licensed Practical Nurse (LPN) that he has noticed weight gain recently, and although he hasn't checked his weight, he can no longer button his pants comfortably. At the beginning of the evening shift, the LPN assesses Mr. Harris and observes swollen feet and clammy skin. He is alert and answers questions without difficulty. His vital signs are as follows: blood pressure at 148/92 mmHg, pulse at 108 bpm, respiratory rate at 28 bpm, and SpO2 at 90% on room air. A fluid restriction of 1500 ml per day has been prescribed. Which of the following clinical manifestations relates to the LPN's concerns? *
3. A 60-year-old patient is hospitalized for chest pain under the left clavicle, rated 8/10 and radiating in the left scapular area. The patient tells the LPN that he has trouble breathing when he turns over in the bed and that the pain increases while coughing. He feels relief, however, when he adopts a sitting position. The LPN notes that the patient’s face is pale and that he is complaining of nausea without vomiting. She takes the patient’s vital signs, which are as follows: BP at 175/100, pulse at 112 bpm, resp at 32 bpm, SpO2 at 95% and temperature at 38.8. An ECG and a blood culture are requested STAT because the doctor suspects pericarditis. Which of the following clinical manifestations relates to the patient’s condition? *
4. Ms. Pelletier, 73, with a history of hypertension and thyroid imbalance, presents feeling unusually lightheaded. She reports a “fluttering” in her chest that started earlier in the morning. While waiting, she suddenly becomes short of breath and feels her heart racing irregularly. Her skin becomes cool, and she reports mild chest pressure. The LPN obtains a pulse and notes it is irregular and rapid. The physician suspects atrial fibrillation with rapid ventricular response (RVR). Which of the following clinical manifestations relates to the patient’s condition? *
5. Mr. Caron, 61, has a past history of controlled coronary artery disease. He reports chest pressure every time he climbs stairs but states it usually disappears after resting. Today, while walking to the clinic, he experienced the familiar pressure lasting a few minutes, which subsided when he sat down. He looks calm yet slightly concerned. The LPN documents the symptoms and informs the physician, who suspects stable angina. Which clinical manifestation relates to the patient’s condition? *
6. Ms. Fortin, 56, has been managing mild angina for years. Today, she arrives reporting chest pain that began suddenly while she was sitting at home. She says, “This time it won’t go away like it usually does.” She appears pale, and the pain increases despite rest. The LPN initiates protocol and alerts the medical team. The physician suspects unstable angina. Which manifestation is associated with this condition? *
7. Mr. Singh, 48, recently had knee surgery and has been less active. At the clinic, he suddenly becomes short of breath, appearing visibly distressed. He clutches his chest and reports sharp pain that worsens with deep breathing. His respiratory rate increases and he describes a sense of impending doom. The LPN calls emergency services. The physician suspects pulmonary embolism. Which clinical manifestation relates to the patient’s condition? *
8. Mr. Desrosiers, 79, with a history of valvular disease, comes to the clinic after experiencing dizziness while walking. He reports exertional chest discomfort and a recent episode of near-fainting while climbing stairs. He becomes slightly breathless during assessment. The LPN notes a systolic murmur. The physician suspects aortic stenosis. Which manifestation is consistent with this diagnosis? *
9. Ms. Alvarez, 52, has uncontrolled hypertension. Today she arrives with a severe headache, blurred vision, and increasing confusion. She reports chest pressure that started earlier in the day and now feels “pounding” behind her eyes. Her speech becomes slightly disorganized. The LPN checks her blood pressure and finds it critically high. The physician suspects hypertensive emergency. Which clinical manifestation relates to her condition? *
10. Mr. Dufresne, a 44-year-old man with a history of viral infections during winter seasons, arrives at the clinic complaining of mild chest discomfort. He reports that the discomfort worsened over the past two days, especially when lying flat. He denies a history of cardiac disease but notes he has recently recovered from a flu-like illness. While sitting in the waiting room, he begins to feel sharp, stabbing chest pain that improves when he leans forward. He becomes slightly anxious as the pain intensifies during inspiration. The LPN escorts Mr. Dufresne to an exam room, obtains vital signs, and notifies the physician. Based on his symptoms, the physician suspects acute pericarditis. Which of the following clinical manifestations relates to the patient’s condition? *
11. Mr. Laramée, 67, with known congestive heart failure, arrives at the clinic feeling unusually fatigued. He reports that over the past week, he has been sleeping on two pillows due to difficulty breathing. While he waits, he begins coughing pink, frothy sputum and becomes increasingly short of breath. The LPN notices swelling in his ankles and hears him complaining of “tightness in the chest.” Upon assessment, the LPN notes crackles in the lungs. The physician suspects acute heart failure exacerbation. Which clinical manifestation relates to the patient’s condition? *
12. Mrs. Yvonne Martel, 81, is admitted for increasing fatigue, shortness of breath on exertion, and poor appetite over the past week. Her medical history includes chronic atrial fibrillation, systolic heart failure (EF 32%), hypertension, and chronic kidney disease stage 3. She takes digoxin 0.125 mg daily, furosemide, ramipril, and warfarin.

During morning assessment, she reports nausea and states that “everything tastes metallic.” She also complains of seeing “yellow halos” around lights. Her daughter mentions that Mrs. Martel has been more confused and had difficulty walking straight today. The nurse reviews her chart and finds that she recently had reduced kidney function (creatinine rising from 110 to 178 µmol/L) and potassium decreased from 4.1 to 3.2 mmol/L after increasing her furosemide dose at home.

An hour later, the telemetry monitor alarms: the patient is now showing frequent premature ventricular contractions with episodes of bradycardia (HR 48 bpm). Vitals: BP 94/56 mmHg, RR 18/min, SpO₂ 95% RA. Mrs. Martel becomes increasingly dizzy and says, “I feel like I’m going to faint.”

Which complication should the nurse suspect based on this clinical picture? *
13. Mr. Daniel Gagnon, 68, arrives at the emergency department after experiencing crushing substernal chest pain radiating to his left arm for the past 45 minutes. He reports nausea, diaphoresis, and shortness of breath. His history includes type 2 diabetes, hypertension, obesity, and hyperlipidemia. He states he missed his last two doses of metoprolol and ran out of nitroglycerin at home. Initial ECG shows ST-segment elevation in leads V2–V5. He receives aspirin, oxygen, and sublingual nitroglycerin.

Two hours later, the nurse notes a sudden change: Mr. Gagnon becomes extremely anxious and confused. His skin is pale and cool, radial pulses are weak and thready, and he reports “I feel like I’m going to pass out.” Current vitals: BP 74/40 mmHg, HR 132 bpm, RR 30/min, SpO₂ 89% on 4 L nasal cannula. Urine output has dropped to 10 mL over the past hour. Lung auscultation reveals crackles in both lower lobes.

Which complication is the nurse most concerned about? *
14. Mrs. Claudette Nadeau, 77, with known systolic heart failure (EF 28%), arrives at the hospital with a 3-day history of worsening lower-extremity edema, orthopnea, and weight gain of 3.2 kg. She reports running out of her furosemide and “trying to drink a lot of water to stay hydrated.” On admission, vitals include BP 158/92 mmHg, HR 108 bpm, RR 22/min, and SpO₂ 94% on room air. Chest X-ray shows cardiomegaly.

At 02:30 a.m., the nurse responds to Mrs. Nadeau’s call bell. She is sitting upright, gasping for air, with pink frothy sputum on her lips. She says, “I can’t breathe… please help me.” Her RR is 36/min, HR 132 bpm, and SpO₂ has fallen to 82% despite oxygen at 6 L/min via nasal cannula. Lung auscultation reveals loud crackles in all lung fields. The nurse notes cool extremities and restlessness.

Which complication is developing? *
15. Mr. Rosario Silva, 72, has a history of chronic atrial fibrillation, hypertension, and mild chronic kidney disease. He has been inconsistent with his anticoagulation because “the pills upset my stomach.” During triage, he reports palpitations, occasional dizziness, and mild fatigue but denies chest pain. His HR is irregular at 118 bpm, BP 146/84 mmHg, and he is otherwise stable.

Four hours later on the unit, the nurse notices Mr. Silva suddenly has difficulty speaking. He tries to answer a question but can only produce slurred, fragmented sounds. His right arm drifts downward when he attempts to lift both arms. Facial asymmetry is noted on the right side, and he appears frightened. His BP rises to 168/92 mmHg, HR remains irregular, and his glucose is normal.

Which complication is the nurse witnessing? *
16. Mrs. Amina Benali, 63, with a 10-year history of stable angina, arrives at the clinic reporting increased chest pressure over the past week. She notes the discomfort is now occurring with lighter activity and sometimes at rest. She usually relieves her angina with nitroglycerin but reports needing “more doses than usual.” Her history includes smoking, hyperlipidemia, and poorly controlled hypertension.

During her assessment, she begins clutching her chest, describing the pain as “an elephant sitting on me.” She becomes pale and diaphoretic. The pain radiates to her jaw and left arm. Vitals show BP 162/88 mmHg, HR 118 bpm, RR 28/min, and SpO₂ 92%. The monitor reveals ST-segment elevation in leads II, III, and aVF. She becomes nauseous and vomits.

Which complication of stable angina is occurring? *
17. Mr. Xavier Dubois, 66, has longstanding uncontrolled hypertension and a history of smoking two packs per day for 30 years. He presents to the ED with vague abdominal discomfort and back stiffness for two days. He reports feeling a “pulsing” sensation in his abdomen. On assessment, his BP is 178/96 mmHg, HR 102 bpm, and he appears mildly uncomfortable. A pulsatile abdominal mass is palpable but non-tender.

While awaiting ultrasound, Mr. Dubois suddenly screams in pain, clutching his abdomen. He becomes pale, diaphoretic, and collapses onto the stretcher. His BP drops to 68/40 mmHg, HR rises to 142 bpm, and his skin becomes cool and mottled. The abdominal mass is now firm and intensely tender.

Which complication has most likely occurred? *
18. Ms. Julie Caron, 54, with a history of mitral valve prolapse, visits the clinic reporting low-grade fever, fatigue, and new onset of painful red lesions on her fingertips. She mentions recent dental work without prophylactic antibiotics. Auscultation reveals a systolic murmur and faint crackles. Her CRP is elevated, and blood cultures are pending.

During assessment, Ms. Caron suddenly reports severe headache and blurred vision. She then becomes confused and unable to maintain balance when attempting to stand. Her left arm shows decreased strength compared to the right. Vitals show BP 152/88 mmHg, HR 104 bpm.

Which complication is most likely occurring? *
19. Mr. Hassan Khouri, 48, diagnosed with viral pericarditis, is admitted for worsening chest pain over 4 days. He describes the pain as sharp and improved when leaning forward. He has a low-grade fever, pericardial rub, and mild tachycardia. He is started on NSAIDs and monitored.

On the second hospital day, Mr. Khouri becomes acutely short of breath. The nurse notes his skin is cool and pale. His jugular veins are distended, and his BP has dropped from 128/82 to 86/50 mmHg. Heart sounds are now distant and muffled. He appears restless and says, “I feel like I’m suffocating.” Pulsus paradoxus is present at 16 mmHg.

Which complication is developing? *
20. Mr. Samuel Fortier, 73, with moderate-to-severe aortic stenosis, reports increasing exertional dyspnea, dizziness, and occasional chest pressure. He denies medication changes. Heart sounds reveal a harsh systolic murmur. His BP is 132/72 mmHg and HR 92 bpm.

Later in the evening, Mr. Fortier becomes extremely short of breath. He begins coughing up frothy sputum and is unable to lie flat. His RR is 34/min, HR 121 bpm, and SpO₂ is 84% on 6 L oxygen. Crackles are heard throughout both lung fields.

Which complication is the nurse observing? *
21. Ms. Teresa Alvarez, 52, has a history of poorly controlled hypertension, obesity, and type 2 diabetes. She arrives at the ED complaining of severe headache, blurred vision, and chest tightness. She reports missing her antihypertensive medications for 4 days. Her initial BP is 216/124 mmHg, HR 104 bpm. ECG shows LV hypertrophy.

During monitoring, she becomes disoriented and complains of nausea and new left-sided weakness. The nurse notices slurred speech and unequal pupil size. Repeat BP is 228/132 mmHg. She grabs her head and says, “The pain is worse… I can’t see.”

Which hypertensive complication is occurring? *