In class quiz 3

Which blood pressure reading is considered to be indicative of prehypertension according to the JNC-7 criteria?

128/82 Response Feedback: In adults, a normal blood pressure is <120 mm Hg systolic and <80 mm Hg diastolic pressure. Stage 1 hypertension begins with a systolic pressure of 140 mm Hg or a diastolic pressure of 90 mm Hg. Between these values, the individual is said to have prehypertension, and interventions related to lifestyle changes should be initiated for primary hypertension. 118/78 is considered normal. An individual with a reading of 140/88 or 138/94 may be considered to have stage 1 hypertension.

Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock?

Anaphylactic Response Feedback: Exposure to a specific antigen causes receptors on mast cells and basophils to cross-link and activate histamine. The release of histamine along with other vasoactive chemicals produces bronchoconstriction. Cardiogenic shock is not associated with histamine release. Hypovolemic shock is not associated with histamine release. Histamine release does not occur with neurogenic shock.

A patient is admitted to the hospital with left-sided heart failure. Which clinical manifestation would the nurse expect the client to exhibit? (Select all that apply.)

Cough Dyspnea Crackles in lungs Response Feedback: Common clinical manifestations of left-sided heart failure include cough, dyspnea, and crackles in lungs upon auscultation. Bradypnea describes abnormal slowness of breathing not seen in left-sided heart failure. Peripheral edema is associated with right-sided heart failure.

What is the marker of choice for detecting a myocardial infarction?

Elevated serum levels of cardiac troponin Response Feedback: Two proteins that make up part of the cardiac cell contractile apparatus, troponins I and T, have become the markers of choice for detecting MI. Cardiac troponin levels become elevated in serum at about the same time as CK-MB, but they remain elevated for a longer period. ST-segment elevation is thought to represent acute cell injury and ischemia. An elevated level of serum CK-MB is a highly specific indicator of MI and considered to be diagnostic. However, CK-MB remains elevated for only 48 to 72 hours after MI. Cardiac myoglobin levels are elevated in serum very quickly after MI and may be helpful in early detection; however, cardiac myoglobin is less specific than the other markers.

While hospitalized, an elderly patient with a history of myocardial infarction was noted to have high levels of low-density lipoproteins (LDLs). What is the significance of this finding?

Increased LDL levels are associated with increased risk of coronary artery disease. Response Feedback: High levels of low-density lipoproteins (LDLs), which are high in cholesterol, have been associated with the highest risk of coronary atherosclerosis. Even when lipid metabolism is normal, a high-fat diet can overwhelm the liver's ability to clear LDL cholesterol from the circulation and result in hyperlipidemia. Dietary fat restriction may be beneficial in reducing cholesterol in this case. Increased LDL levels are not indicative of alcohol intake. Elevated LDL levels are not an expected finding in the elderly and should be treated.

The shift to anaerobic metabolism in shock results in

Increased lactate production Response Feedback: When the citric acid cycle is inhibited, pyruvate accumulates in the cytoplasm. Pyruvate accumulation would quickly inhibit further glycolysis and shut down ATP production entirely except that it can be converted to a substance called lactate, which diffuses from the cell and into the extracellular fluid. A shift to anaerobic metabolism in shock does not result in metabolic alkalosis, decreased oxygen utilization, or decreased hydrogen ion production.

Which describes a pathologic manifestation of neurogenic shock?

Loss of sympathetic activation of arteriolar smooth muscle Response Feedback: Neurogenic shock results from loss of sympathetic activation of arteriolar smooth muscle. Medullary depression (brain injury, drug overdose) or lesions of sympathetic nerve fibers (spinal cord injury) are the usual causes. Release of vasodilatory mediators such as histamine into the circulation and massive immune system activation are seen in anaphylactic shock. Increased sympathetic nervous stimulation is not a characteristic of neurogenic shock.

Which condition may result in chronic pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure?

Mitral valve stenosis Response Feedback: Pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure result from untreated mitral valve stenosis. Syncope, fatigue, low systolic blood pressure, and faint pulses are common signs and symptoms of aortic valve stenosis. Aortic insufficiency is characterized by a high-pitched blowing murmur during ventricular diastole. Patients may complain of palpitations and a throbbing or pounding heart because of the large ventricular stroke volume. Common presenting symptoms of acute myocarditis include fatigue, dyspnea on exertion, and dysrhythmia with associated palpitations.

Which causes of shock are considered to be obstructive? (Select all that apply.)

Pulmonary embolus Cardiac tamponade Tension pneumothorax Response Feedback: Pulmonary embolism is a mechanical obstruction of blood flow, which results in elevated right-sided heart pressures but left-sided pressures remain normal. Cardiac tamponade results from an accumulation of fluid in the pericardial sac causing elevation of pressures on both sides of the heart. Tension pneumothorax results in shifting and compression of mediastinal structures including the heart, which compromises left ventricular filling. Ventricular rupture is not associated with obstructive shock. Acute hemorrhage is associated with hypovolemic shock.

Which type of shock is characterized by generalized vasodilation and peripheral pooling of blood? (Select all that apply.)

Septic Neurogenic Anaphylactic Response Feedback: Septic shock, neurogenic shock, and anaphylactic shock are characterized by excessive vasodilation and peripheral pooling of blood. Cardiac output is inadequate because of reduced preload. Cardiogenic shock occurs primarily as a result of severe dysfunction of the left or right ventricles, or both, that results in inadequate cardiac pumping. Hypovolemic shock is a result of excessive blood loss; vasoconstriction is initially seen in this form of shock.

Restriction of which electrolytes is recommended in the management of high blood pressure?

Sodium Response Feedback: The balance of the intake of water and sodium with their excretion by the kidney remains the central feature of long-term blood pressure maintenance. Sodium is not rapidly eliminated by the kidney like water and adds to the body's fluid volume. It is not necessary to restrict the intake of calcium when managing high blood pressure. Potassium does not need to be restricted in the management of high blood pressure. Magnesium does not play a role in the management of high blood pressure.

Cardiac output is the product of both

Stroke volume and heart rate Response Feedback: The product of stroke volume and heart rate provides the amount of cardiac output. None of the other options (MAP, SVR, or pulse pressure) are factors in cardiac output.

Angiotensin-converting enzyme (ACE) inhibitors block the

conversion of angiotensin I to angiotensin II. Response Feedback: Angiotensin I is converted into angiotensin II while it is circulating through the pulmonary vessels, by the angiotensin converting enzyme. ACE inhibitors block the conversion of angiotension I to angiotension II. Renin plays a role in the regulation of arterial blood pressure. ACE inhibitors do not block the conversion of angiotensinogen to angiotensin or the effect of aldosterone on the kidney.

A patient presents to the emergency department with a diastolic blood pressure of 132 mm Hg, retinopathy, and symptoms of an ischemic stroke. This symptomology is likely the result of

hypertensive crisis. Response Feedback: Hypertensive crisis is characterized by a diastolic blood pressure of greater than 120 mm Hg, and symptoms of end-organ damage such as retinopathy and ischemic stroke. Blood pressure is not an indication of arthrosclerosis Angina may accompany hypertensive crisis, but the question stem relates directly to hypertensive crisis. The patient may be having a myocardial infarction, but the addition of end-organ damage symptoms point to hypertensive crisis.

A patient who was involved in a fall from a tree becomes short of breath. The lung sounds are absent on one side. Patient is diagnosed with a pneumothorax. This patient is experiencing ________ shock.

obstructive Response Feedback: This type of obstructive shock is the result of a tension pneumothorax and is caused by shifting and compression of mediastinal structures including the heart, which compromise left ventricular filling. Accumulation of air in the pleural space may occur because of trauma. Prompt relief of the obstructive event is necessary to restore cardiac output and prevent cardiovascular collapse. Cardiogenic shock is not related to a traumatic event. Hypovolemic shock results when circulating blood volume is inadequate to perfuse tissues. Distributive shock is characterized by an abnormally expanded vascular space caused by excessive vasodilation.

A patient with heart failure who reports intermittent shortness of breath during the night is experiencing

paroxysmal nocturnal dyspnea. Response Feedback: Dyspnea that occurs at night is known as paroxysmal nocturnal dyspnea. Orthopnea is known as dyspnea when lying down. Intermittent shortness of breath at night is not known as paroxysmal atrial tachycardia. Sleep apnea is an absence of breathing during sleep.

Hypotension associated with neurogenic and anaphylactic shock is due to

peripheral pooling of blood. Response Feedback: Profound peripheral vasodilation of both arterioles and veins leads to peripheral pooling of blood and hypotension. Decreased venous return to the heart results in decreased cardiac output and hypotension. Hypovolemia is not the source of the hypotension involved in neurogenic and anaphylactic shock. Cardiac output is generally adequate in neurogenic and anaphylactic shock. Hypotension in neurogenic and anaphylactic shock is not related to high afterload.

The common denominator in all forms of heart failure is

reduced cardiac output. Response Feedback: The common manifestation of all forms of heart failure is the failure of the heart to pump blood adequately. The clinical presentation may differ depending on which ventricle fails (left or right, or both). Poor diastolic filling is not seen in all forms of heart failure. Pulmonary edema is seen in left-sided failure. Tissue ischemia is directly related to myocardial infarction, which may induce heart failure.

Cor pulmonale refers to

right ventricular hypertrophy secondary to pulmonary hypertension. Response Feedback: Pulmonary disorders that result in increased pulmonary vascular resistance impose a high afterload on the right ventricle. The resultant right ventricular hypertrophy known as cor pulmonale may progress to right ventricular failure as the lung disease worsens. Biventricular failure is most often the result of primary left ventricular failure that progresses to the right. Cor pulmonale is not associated with left ventricular hypertrophy. Only 3% of MIs occur in the right ventricle.

Rheumatic heart disease is most often a consequence of

β-hemolytic streptococci infection Response Feedback: Rheumatic heart disease is an uncommon but serious consequence of rheumatic fever. Rheumatic fever is an acute inflammatory disease that follows infection with group A β-hemolytic streptococci. Rheumatic heart disease is not associated with chronic IV drug abuse. Rheumatic fever is an acute inflammatory infectious disease. Cardiomyopathy does not cause rheumatic heart disease.